title: Mitral durability after robotic mitral valve repair: analysis of 200 consecutive mitral regurgitation repairs.
abstract: OBJECTIVE
  The study objective was to review a single-center experience on robotic mitral valve repair to treat mitral regurgitation, with a specific focus on midterm echocardiographic mitral durability. No data assessing the quality or durability of repaired mitral valves are currently available.
  
  
  METHODS
  A total of 200 patients who underwent robotic mitral regurgitation repair using the da Vinci system (Intuitive Surgical, Inc, Sunnyvale, Calif) between August 2007 and December 2012 were evaluated. Serial echocardiographic results and operative and procedural times were analyzed.
  
  
  RESULTS
  Mitral regurgitation repairs were successfully performed, and no or mild residual mitral regurgitation developed in 98.0% of patients, with no conversion to sternotomy. No in-hospital deaths occurred. Follow-up was completed in 96.5% of patients with a median of 31.4 months (interquartile range, 12.4-42.3 months). During follow-up, 4 late deaths, 2 strokes, 1 low cardiac output, 1 newly required dialysis, and 1 reoperation for mitral regurgitation occurred. Freedom from major adverse cardiac events at 5 years was 87.7% ± 5.1%. Regular echocardiographic follow-up (>6 months) was achieved in 187 patients (93.5%). At a median of 29.6 months (interquartile range, 14.9-45.8 months), 21 patients (10.5%) demonstrated moderate or greater mitral regurgitation. Freedom from moderate or greater mitral regurgitation at 5 years was 87.0% ± 2.6%. Mean cardiopulmonary bypass and crossclamping times were 182.9 ± 48.4 minutes and 110.9 ± 34.1 minutes, respectively, demonstrating a significant decrease in both times according to the chronologic date of surgery.
  
  
  CONCLUSIONS
  Robotic mitral regurgitation repair is technically feasible and efficacious, demonstrating favorable midterm mitral durability and improved procedural times as experience increases.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Jae Suk
authors.initials: JS
authors.lastname: Yoo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Joon Bum
authors.initials: JB
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Sung-Ho
authors.initials: SH
authors.lastname: Jung
authors.affiliation: Department of Cardiology, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Dae-Hee
authors.initials: DH
authors.lastname: Kim
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Suk Jung
authors.initials: SJ
authors.lastname: Choo
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea.
authors.forename: Cheol Hyun
authors.initials: CH
authors.lastname: Chung
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, Korea. Electronic address: jwlee@amc.seoul.kr.
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Lee
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D061646:Operative Time; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012371:Robotics; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography