Robotic mitral valve repair for all categories of leaflet prolapse: improving patient appeal and advancing standard of care

Abstract

Objective: To characterize the early outcomes of robotic mitral valve (MV) repair using standard open techniques.

Patients and methods: We prospectively studied 100 patients with severe mitral regurgitation due to leaflet prolapse who underwent robot-assisted MV repair using conventional open-repair techniques between January 1, 2008, and December 31, 2009, at Mayo Clinic, Rochester, MN.

Results: The mean age of the patients was 53.9 years; 77 patients (77%) were male. Fifty-nine patients (59%) had posterior leaflet prolapse, 38 (38%) had bileaflet disease, and 3 (3%) had isolated anterior leaflet prolapse. Median cross-clamp and bypass times decreased significantly during the course of the study (P<.001). Median postoperative ventilation time was 0 hours for the last 25 patients, with most patients extubated in the operating room. No deaths occurred. Reexploration for postoperative bleeding occurred in 1 patient (1%); 3 patients (3%) required percutaneous coronary intervention. Median hospital stay was 3 days. One patient (1%) underwent mitral reoperation for annuloplasty band dehiscence. Residual regurgitation was mild or less in all patients at dismissal and 1 month postoperatively. Significant reverse remodeling occurred by 1 month, including decreased left ventricular end-diastolic diameter (-7.2 mm; P<.001) and left ventricular end-diastolic volume (-61.0 mL;P<.001).

Conclusion: Robot-assisted MV repair using proven, conventional open-repair techniques is reproducible and safe and hastens recovery for all categories of leaflet prolapse. One month after surgery, significant regression in left ventricular size and volume is evident.

FIGURE.

Improvements in outcomes by quartile, based on chronological date of operation. Significant decreases in median cardiopulmonary bypass perfusion time (r=–0.6) (A), median aortic cross-clamp time (r=–0.6) (B), postoperative median ventilation durations (r=–0.7) (C), and median postoperative length of stay (r=–0.4) (D) were documented over time when patients were divided into quartiles based on chronological date of operation (all P<.001, Spearman rank correlation test). (One outlier who required a longer duration of ventilation during postoperative mechanical support was not included in the test of postoperative ventilation data between quartiles.)