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J Thorac Cardiovasc Surg 2008;136:436-441
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Robotic mitral valve repairs in 300 patients: A single-center experience

^a Department of Cardiovascular Sciences, East Carolina Heart Institute, East Carolina University, Greenville, NC
^b Department of Biostatistics, East Carolina Heart Institute, East Carolina University, Greenville, NC

Received for publication January 10, 2008; revisions received March 9, 2008; accepted for publication March 27, 2008.

^_* Address for reprints: W. Randolph Chitwood, Jr, MD, Department of Cardiovascular Sciences, East Carolina University, 600 Moye Blvd, Greenville, NC 27858. (Email: chitwoodw{at}ecu.edu).

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.