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Ann Thorac Surg 2005;79:1372-1376
© 2005 The Society of Thoracic Surgeons

New technology

Robotic Mitral Valve Annuloplasty With Double-Arm Nitinol U-Clips

Clifton C. Reade, MD*, Curtis E. Bower, MD, B. Marcus Bailey, MD, David M. Maziarz, MD, Saqib Masroor, MD, Alan P. Kypson, MD, L. Wiley Nifong, MD, W. Randolph Chitwood, Jr, MD, FACS

Division of Cardiothoracic Surgery, The Brody School of Medicine at East Carolina University, Greenville, North Carolina, USA

Accepted for publication February 18, 2004.

* Address reprint requests to Dr Reade, Department of Surgery, The Brody School of Medicine at East Carolina University, 600 Moye Blvd, Greenville, NC 27858, USA.
readec{at}mail.ecu.edu

Presented at the Video Session of the Fiftieth Annual Meeting of the Southern Thoracic Surgical Association, Bonita Springs, FL, Nov 13–15, 2003.

PURPOSE: Robotic mitral valve repair increases precision however operative times are longer. Prior studies have indicated that robotic knot tying is time consuming and it is without potential room for improvement. We therefore investigated tissue approximation devices that may shorten operative times.

DESCRIPTION: A 67-year-old female was approached through a right mini-thoracotomy with the da Vinci Robotic Surgical System (Intuitive Surgical, Sunnyvale, CA). Using 12 nitinol U-clips (Coalescent Surgical, Sunnyvale, CA) an annuloplasty band was placed under robotic guidance. Clip placement and deployment times were recorded and statistical comparisons were assessed to prior suture annuloplasties.

EVALUATION: Clip placement time was 1.3 ± 0.9 (minutes ± standard deviation), statistical comparison with first, most recent, and all prior suture annuloplasties proving no significance. Clip deployment time was 0.5 ± 0.2, whereas knot-tying times and respective statistical comparison for first, most recent, and all prior suture annuloplasties were 2.0 ± 0.7 (p = 0.003), 1.2 ± 0.4 (p = 0.0004), and 1.6 ± 0.6 (p < 0.00001). Follow-up echocardiography performed postoperatively, at 3 months, and at 9 months revealed valvular structural integrity with only minimal mitral regurgitation.

CONCLUSIONS: U-clips considerably reduce time for annuloplasty over conventional suture and may help reduce operative times as well.

Abbreviations: AH = arrested heart • CDT = clip deployment time • CPB = cardiopulmonary bypass • CPT = clip placement time • KTT = knot tying time • RMVR = robotic mitral valve repair • RMVR-AVG = average of all prior robotic mitral valve repairs (using suture) • RMVR-1 = first patient receiving robotic mitral valve repair (using suture) • RMVR-69 = 69th patient receiving robotic mitral valve repair (using suture; performed one week prior to reported case) • SPT = suture placement time • TEE = transesophageal echocardiography • VAMVR = videoscopic assisted mitral valve repair




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