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J Thorac Cardiovasc Surg 2008;135:610-614
© 2008 The American Association for Thoracic Surgery

Evolving Technology

Endoscopic placement of multiple artificial chordae with robotic assistance and nitinol clip fixation

^a Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio
^b Intuitive Surgical Inc, Clinical Development Engineering, Sunnyvale, California

Received for publication June 11, 2007; revisions received October 8, 2007; accepted for publication October 15, 2007.

^_* Address for reprints: J. Michael Smith, MD, c/o Amy Engel, Hatton Institute, Good Samaritan Hospital, 375 Dixmyth Ave, Cincinnati, OH 45220. (Email: amy_engel{at}trihealth.com).

Objective: A totally endoscopic method of placing multiple premeasured artificial chordae with the assistance of the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, Calif) and V60 U-clip devices (Medtronic Inc, Minneapolis, Minn) was evaluated.

Methods: Totally endoscopic placement of multiple artificial chordae with robotic assistance and nitinol clips was performed in 30 patients. After subvalvular exposure with a robotically controlled Atrial Retractor (Intuitive Surgical Inc), artificial chordae constructed of 4-0 polytetrafluoroethylene (Gore-Tex; WL Gore & Associates Inc, Flagstaff, Ariz) were secured to the prolapsing leaflet edge with V60 U-clips. Transesophageal echocardiography to assess successful repair was performed.

Results: Repairs of the anterior leaflet, the posterior leaflet, and combinations of both were performed. Crossclamp and cardiopulmonary bypass times were in the range of 78.63 ± 17.03 minutes and 118.17 ± 22.55 minutes, respectively. Transesophageal echocardiography showed grade 0 to less than grade 1 mitral regurgitation postoperatively. All patients had an uneventful recovery phase and were discharged within 5 days.

Conclusion: Endoscopic placement of premeasured artificial neochordae is greatly facilitated by applying robotic assistance and using nitinol clips for chordae fixation. The endoscopic robotic technique provides excellent functional and clinical outcomes.