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Original Articles: Cardiovascular

Robotic Mitral Valve Repair for Anterior Leaflet and Bileaflet Prolapse

^a Division of Cardiothoracic and Vascular Surgery, Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, North Carolina
^b Division of Cardiology, Department of Medicine, Brody School of Medicine, East Carolina University, Greenville, North Carolina
^c Department of Biostatistics, Brody School of Medicine, East Carolina University, Greenville, North Carolina

Accepted for publication April 30, 2007.

^_* Address correspondence to Dr Rodriguez, Division of Cardiothoracic and Vascular Surgery, East Carolina University, 600 Moye Blvd, Teaching Annex #257, Greenville, NC 27858 (Email: rodrigueze{at}ecu.edu).

Presented at the Fifty-third Annual Meeting of the Southern Thoracic Surgical Association, Tucson, AZ, Nov 8–11, 2006.

Background: Centers have expanded indications for robotic mitral valve repairs to include complex pathologic features. We studied our results after robotic mitral valve repair for anterior leaflet or bileaflet prolapse.

Methods: Data were collected contemporaneously on 289 patients operated on from May 2000 to September 2006. Every patient underwent preoperative transesophageal echocardiography. Follow-up consisted of serial echocardiograms, clinic visits, and phone conversations with patients and their physicians.

Results: A total of 66 patients (anterior leaflet, n = 14; and bileaflet, n = 52) were identified. Mean age was 52.6 ± 7.1 years, and 57 (86%) patients had New York Heart Association functional class II or III symptoms. Cardiopulmonary bypass and cross-clamp times were 171 ± 52 and 132 ± 39 minutes, respectively. The 30-day and late mortality rates were 3% (n = 2) for each time point. There were no device-related or perfusion-related complications or sternotomy conversions. Complications included 2 strokes (3%), 2 bleeding reexplorations (3%), and 10 pleural effusions requiring intervention (15%). The length of hospital stay for surviving patients was 5 ± 3 days, and time to extubation averaged 9.5 ± 13 hours. A total of 6 (9%) patients required valve reoperation. Mean follow-up was 795 ± 495 days, and echocardiographic mitral regurgitation (n = 60) was none or trace (n = 35, 58.3%), mild (n = 19, 31.6%), moderate (n = 2, 3.3%), and severe (n = 4, 6.7%).

Conclusions: Robotic mitral valve repair for anterior leaflet and bileaflet prolapse is feasible and safe. Outcomes and degree of late mitral regurgitation are similar to series using conventional techniques. Long-term follow-up is required to formally address the efficacy of robotic repair techniques.

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