Robotic mitral valve repairs requiring reoperations

Evelio Rodriguez, Michael W.A. Chu, John Narron, Karen Gersch, L. Wiley Nifong, W. Randolph Chitwood

    Research output: Contribution to journalArticle

    3 Citations (Scopus)

    Abstract

    OBJECTIVE: Robotic mitral valve (MV) repairs are performed at many institutions. Repair failures have been attributed to the challenging technology and potentially to the use of annuloplasty band anchoring U-clips. The purpose of this study was to characterize causes of robotic MV repair failure. METHODS: A total of 300 patients underwent a da Vinci robotic MV repair between May 2000 and November 2006 by a single operating console surgeon. Standard repair techniques and a Cosgrove annuloplasty band were used in every case. Clinical data in patients requiring a reoperation, as well as videos of their original operation, were reviewed. MV pathology, repair methods, and findings at reoperation were determined. RESULTS: Sixteen (5.3%) patients required reoperation. Seven (7%) failures occurred in the first 100 cases and 9 (4.5%) in the last 200 cases. Initial MV pathology included isolated anterior (n = 4) or posterior leaflet prolapse (n = 6), bileaflet prolapse (n = 3), and annular dilation (n = 3). Reoperations after their initial operation were required early (<6 months) in 8 patients and later in 8 patients. Reasons for reoperation included CHF (n = 9), hemolysis (n = 4), systolic anterior leaflet motion (n = 2), and endocarditis (n = 1). At reoperation, 7 patients had partial dehiscence of the annuloplasty band. The incidence of band dehiscence was not associated with the use of U-clips and decreased with experience. CONCLUSIONS: Reoperative rates seemed to decrease with increased case volume and surgeon's experience. Repair results using robotic techniques are similar to conventional techniques. The use of U-clips is not associated with a higher reoperation rate.

    Original languageEnglish (US)
    Pages (from-to)12-15
    Number of pages4
    JournalInnovations: Technology and Techniques in Cardiothoracic and Vascular Surgery
    Volume3
    Issue number1
    DOIs
    StatePublished - Jan 1 2008

    Fingerprint

    Robotics
    Mitral Valve
    Reoperation
    Surgical Instruments
    Prolapse
    Pathology
    Hemolysis
    Endocarditis
    Dilatation
    Technology
    Incidence

    All Science Journal Classification (ASJC) codes

    • Surgery
    • Cardiology and Cardiovascular Medicine

    Cite this

    Robotic mitral valve repairs requiring reoperations. / Rodriguez, Evelio; Chu, Michael W.A.; Narron, John; Gersch, Karen; Nifong, L. Wiley; Chitwood, W. Randolph.

    In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, Vol. 3, No. 1, 01.01.2008, p. 12-15.

    Research output: Contribution to journalArticle

    Rodriguez, Evelio ; Chu, Michael W.A. ; Narron, John ; Gersch, Karen ; Nifong, L. Wiley ; Chitwood, W. Randolph. / Robotic mitral valve repairs requiring reoperations. In: Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery. 2008 ; Vol. 3, No. 1. pp. 12-15.
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    abstract = "OBJECTIVE: Robotic mitral valve (MV) repairs are performed at many institutions. Repair failures have been attributed to the challenging technology and potentially to the use of annuloplasty band anchoring U-clips. The purpose of this study was to characterize causes of robotic MV repair failure. METHODS: A total of 300 patients underwent a da Vinci robotic MV repair between May 2000 and November 2006 by a single operating console surgeon. Standard repair techniques and a Cosgrove annuloplasty band were used in every case. Clinical data in patients requiring a reoperation, as well as videos of their original operation, were reviewed. MV pathology, repair methods, and findings at reoperation were determined. RESULTS: Sixteen (5.3{\%}) patients required reoperation. Seven (7{\%}) failures occurred in the first 100 cases and 9 (4.5{\%}) in the last 200 cases. Initial MV pathology included isolated anterior (n = 4) or posterior leaflet prolapse (n = 6), bileaflet prolapse (n = 3), and annular dilation (n = 3). Reoperations after their initial operation were required early (<6 months) in 8 patients and later in 8 patients. Reasons for reoperation included CHF (n = 9), hemolysis (n = 4), systolic anterior leaflet motion (n = 2), and endocarditis (n = 1). At reoperation, 7 patients had partial dehiscence of the annuloplasty band. The incidence of band dehiscence was not associated with the use of U-clips and decreased with experience. CONCLUSIONS: Reoperative rates seemed to decrease with increased case volume and surgeon's experience. Repair results using robotic techniques are similar to conventional techniques. The use of U-clips is not associated with a higher reoperation rate.",
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