Robotic mitral valve repairs in 300 patients

A single-center experience

W. Randolph Chitwood, Evelio Rodriguez, Michael W.A. Chu, Ansar Hassan, T. Bruce Ferguson, Paul W. Vos, L. Wiley Nifong

    Research output: Contribution to journalArticle

    107 Citations (Scopus)

    Abstract

    Objectives: Mitral valve repair is the standard therapy for patients with degenerative (myxomatous) disease and severe mitral regurgitation. Robotic mitral valve repair provides the least-invasive surgical approach. We report the largest single-center robotic mitral valve repair experience. Methods: Between May 2000 and November 2006, 300 patients underwent a robotic mitral valve repair (daVinci Surgical System; Intuitive Surgical, Inc, Sunnyvale, Calif). All operations were done with 3- to 4-cm right intercostal access, transthoracic aortic occlusion, and peripheral cardiopulmonary bypass. Repairs included 1 or a combination of trapezoidal/triangular leaflet resections, sliding plasties, chordal transfers/replacements, edge-to-edge approximations, and ring annuloplasties. Echocardiographic and survival follow-up were 93% and 100% complete, respectively. Results: There were 2 (0.7%) 30-day mortalities and 6 (2.0%) late mortalities. No sternotomy conversions or mitral valve replacements were required. Immediate postrepair echocardiograms showed the following degrees of mitral regurgitation: none/trivial, 294 (98%); mild, 3 (1.0%); moderate, 3 (1.0%); and severe, 0 (0.0%). Complications included 2 (0.7%) strokes, 2 transient ischemic attacks, 3 (1.0%) myocardial infarctions, and 7 (2.3%) reoperations for bleeding. The mean hospital stay was 5.2 ± 4.2 (standard deviation) days. Sixteen (5.3%) patients required a reoperation. Mean postoperative echocardiographic follow-up at 815 ± 459 (standard deviation) days demonstrated the following degrees of mitral regurgitation: none/trivial, 192 (68.8%); mild, 66 (23.6%); moderate, 15 (5.4%); and severe, 6 (2.2%). Five-year Kaplan-Meier survival was 96.6% ± 1.5%, with 93.8% ± 1.6% freedom from reoperation. Conclusions: Robotic mitral valve repair is safe and is associated with good midterm durability. Further long-term follow-up is necessary.

    Original languageEnglish (US)
    Pages (from-to)436-441
    Number of pages6
    JournalJournal of Thoracic and Cardiovascular Surgery
    Volume136
    Issue number2
    DOIs
    StatePublished - Aug 1 2008

    Fingerprint

    Robotics
    Mitral Valve
    Mitral Valve Insufficiency
    Reoperation
    Sternotomy
    Survival
    Mortality
    Transient Ischemic Attack
    Cardiopulmonary Bypass
    Length of Stay
    Stroke
    Myocardial Infarction
    Hemorrhage

    All Science Journal Classification (ASJC) codes

    • Surgery
    • Pulmonary and Respiratory Medicine
    • Cardiology and Cardiovascular Medicine

    Cite this

    Chitwood, W. R., Rodriguez, E., Chu, M. W. A., Hassan, A., Ferguson, T. B., Vos, P. W., & Nifong, L. W. (2008). Robotic mitral valve repairs in 300 patients: A single-center experience. Journal of Thoracic and Cardiovascular Surgery, 136(2), 436-441. https://doi.org/10.1016/j.jtcvs.2008.03.053

    Robotic mitral valve repairs in 300 patients : A single-center experience. / Chitwood, W. Randolph; Rodriguez, Evelio; Chu, Michael W.A.; Hassan, Ansar; Ferguson, T. Bruce; Vos, Paul W.; Nifong, L. Wiley.

    In: Journal of Thoracic and Cardiovascular Surgery, Vol. 136, No. 2, 01.08.2008, p. 436-441.

    Research output: Contribution to journalArticle

    Chitwood, WR, Rodriguez, E, Chu, MWA, Hassan, A, Ferguson, TB, Vos, PW & Nifong, LW 2008, 'Robotic mitral valve repairs in 300 patients: A single-center experience', Journal of Thoracic and Cardiovascular Surgery, vol. 136, no. 2, pp. 436-441. https://doi.org/10.1016/j.jtcvs.2008.03.053
    Chitwood, W. Randolph ; Rodriguez, Evelio ; Chu, Michael W.A. ; Hassan, Ansar ; Ferguson, T. Bruce ; Vos, Paul W. ; Nifong, L. Wiley. / Robotic mitral valve repairs in 300 patients : A single-center experience. In: Journal of Thoracic and Cardiovascular Surgery. 2008 ; Vol. 136, No. 2. pp. 436-441.
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    abstract = "Objectives: Mitral valve repair is the standard therapy for patients with degenerative (myxomatous) disease and severe mitral regurgitation. Robotic mitral valve repair provides the least-invasive surgical approach. We report the largest single-center robotic mitral valve repair experience. Methods: Between May 2000 and November 2006, 300 patients underwent a robotic mitral valve repair (daVinci Surgical System; Intuitive Surgical, Inc, Sunnyvale, Calif). All operations were done with 3- to 4-cm right intercostal access, transthoracic aortic occlusion, and peripheral cardiopulmonary bypass. Repairs included 1 or a combination of trapezoidal/triangular leaflet resections, sliding plasties, chordal transfers/replacements, edge-to-edge approximations, and ring annuloplasties. Echocardiographic and survival follow-up were 93{\%} and 100{\%} complete, respectively. Results: There were 2 (0.7{\%}) 30-day mortalities and 6 (2.0{\%}) late mortalities. No sternotomy conversions or mitral valve replacements were required. Immediate postrepair echocardiograms showed the following degrees of mitral regurgitation: none/trivial, 294 (98{\%}); mild, 3 (1.0{\%}); moderate, 3 (1.0{\%}); and severe, 0 (0.0{\%}). Complications included 2 (0.7{\%}) strokes, 2 transient ischemic attacks, 3 (1.0{\%}) myocardial infarctions, and 7 (2.3{\%}) reoperations for bleeding. The mean hospital stay was 5.2 ± 4.2 (standard deviation) days. Sixteen (5.3{\%}) patients required a reoperation. Mean postoperative echocardiographic follow-up at 815 ± 459 (standard deviation) days demonstrated the following degrees of mitral regurgitation: none/trivial, 192 (68.8{\%}); mild, 66 (23.6{\%}); moderate, 15 (5.4{\%}); and severe, 6 (2.2{\%}). Five-year Kaplan-Meier survival was 96.6{\%} ± 1.5{\%}, with 93.8{\%} ± 1.6{\%} freedom from reoperation. Conclusions: Robotic mitral valve repair is safe and is associated with good midterm durability. Further long-term follow-up is necessary.",
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    N2 - Objectives: Mitral valve repair is the standard therapy for patients with degenerative (myxomatous) disease and severe mitral regurgitation. Robotic mitral valve repair provides the least-invasive surgical approach. We report the largest single-center robotic mitral valve repair experience. Methods: Between May 2000 and November 2006, 300 patients underwent a robotic mitral valve repair (daVinci Surgical System; Intuitive Surgical, Inc, Sunnyvale, Calif). All operations were done with 3- to 4-cm right intercostal access, transthoracic aortic occlusion, and peripheral cardiopulmonary bypass. Repairs included 1 or a combination of trapezoidal/triangular leaflet resections, sliding plasties, chordal transfers/replacements, edge-to-edge approximations, and ring annuloplasties. Echocardiographic and survival follow-up were 93% and 100% complete, respectively. Results: There were 2 (0.7%) 30-day mortalities and 6 (2.0%) late mortalities. No sternotomy conversions or mitral valve replacements were required. Immediate postrepair echocardiograms showed the following degrees of mitral regurgitation: none/trivial, 294 (98%); mild, 3 (1.0%); moderate, 3 (1.0%); and severe, 0 (0.0%). Complications included 2 (0.7%) strokes, 2 transient ischemic attacks, 3 (1.0%) myocardial infarctions, and 7 (2.3%) reoperations for bleeding. The mean hospital stay was 5.2 ± 4.2 (standard deviation) days. Sixteen (5.3%) patients required a reoperation. Mean postoperative echocardiographic follow-up at 815 ± 459 (standard deviation) days demonstrated the following degrees of mitral regurgitation: none/trivial, 192 (68.8%); mild, 66 (23.6%); moderate, 15 (5.4%); and severe, 6 (2.2%). Five-year Kaplan-Meier survival was 96.6% ± 1.5%, with 93.8% ± 1.6% freedom from reoperation. Conclusions: Robotic mitral valve repair is safe and is associated with good midterm durability. Further long-term follow-up is necessary.

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