title: The Expanding Role of Endoscopic Robotics in Mitral Valve Surgery: 1,257 Consecutive Procedures.
abstract: BACKGROUND
  The role of robotic instruments in mitral valve (MV) surgery continues to evolve. The purpose of this study was to assess the safety, efficacy, and scope of MV surgery using a lateral endoscopic approach with robotics (LEAR) technique.
  
  
  METHODS
  From 2006 to 2013, a dedicated LEAR team performed 1,257 consecutive isolated MV procedures with or without tricuspid valve repair or atrial ablation. The procedures were performed robotically through five right-side chest ports with femoral artery or ascending aortic perfusion and balloon occlusion. Operative videos and data were recorded on all procedures and reviewed retrospectively.
  
  
  RESULTS
  The mean age of all patients was 59.3 ± 20.5 years, and 8.4% (n = 105) had previous cardiac surgery. The MV repair was performed in 1,167 patients (93%). The MV replacement was performed in 88 patients (7%), and paravalvular leak repair in 2 patients. Concomitant atrial ablation was performed in 226 patients (18%), and tricuspid valve repair in 138 patients (11%). Operative mortality occurred in 11 patients (0.9%) and stroke in 9 patients (0.7%). Predischarge echocardiograms demonstrated mild or less mitral regurgitation in 98.3% of MV repair patients. At mean follow-up of 50 ± 26 months, 44 patients (3.8%) required MV reoperation. Application of the LEAR technique to all institutional isolated MV procedures increased from 46% in the first year to more than 90% in the last 3 years.
  
  
  CONCLUSIONS
  Mitral valve repair or replacement, including concomitant procedures, can be performed safely and effectively using the LEAR technique. With a dedicated robotic team, the vast majority of patients with MV disorders, either isolated or with concomitant problems, can be treated using the LEAR technique.
authors: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: douglas.murphy@emory.edu.
authors: Douglas A
authors: DA
authors: Murphy
authors: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors: Emmanuel
authors: E
authors: Moss
authors: Rollins School of Public Health, Emory University, Atlanta, Georgia.
authors: Jose
authors: J
authors: Binongo
authors: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors: Jeffrey S
authors: JS
authors: Miller
authors: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors: Steven K
authors: SK
authors: Macheers
authors: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors: Eric L
authors: EL
authors: Sarin
authors: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors: Alexander M
authors: AM
authors: Herzog
authors: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors: Vinod H
authors: VH
authors: Thourani
authors: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors: Robert A
authors: RA
authors: Guyton
authors: Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
authors: Michael E
authors: ME
authors: Halkos
mesh_terms: D017548:Echocardiography, Transesophageal; D004724:Endoscopy / Q000379:methods*; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D012371:Robotics / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome