Endoscopic robotic mitral valve surgery

Abstract

Objective: To determine the safety and efficacy of endoscopic mitral valve surgery using robotic instruments through the lateral right chest.

Methods: We conducted a retrospective review of 127 patients taken to the operating room for endoscopic robotic mitral surgery from December 2002 through November 2005. Mean age was 54 +/- 13 years and 58% were male. Mitral regurgitation was 4+ in 121 patients, 3+ in 4 patients, and 2+ in 2 patients. Nineteen (15%) patients had a left ventricular ejection fraction of 0.50 or less. Surgical approach was through 4 right chest ports with femoral perfusion and endoaortic balloon occlusion. Mean follow-up was 13.7 +/- 8.9 months and was 100% complete. Echocardiographic follow-up was available on 98 patients with a mean of 8.4 +/- 8.1 months.

Results: The mitral procedure was completed endoscopically in 121 (95%) patients. Mitral valve repair was performed in 114 patients and mitral valve replacement in 7 patients. Two patients required reoperation on the mitral valve. There was 1 (0.8%) hospital death and 1 late death. Echocardiographic follow-up in 98 survivors of endoscopic mitral repair revealed 0-1+ regurgitation in 95 (96.9%) and 2+ in 3 (3.1%) patients.

Conclusions: Totally endoscopic mitral surgery can be performed safely with robotic instrumentation. A right lateral configuration of the robotic system allows excellent visualization of the valve with minimal distortion and permits two surgical personnel to participate actively in valve instrumentation. In selected patients with mitral valve disease, this surgical approach might promote higher rates of valve repair.