Elizabeth Grodanz1. 1. Elizabeth Grodanz, MSN, BSN, RN Staff Nurse, Cardiac Surgery Department, Operating Room, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
Abstract
BACKGROUND: Mitral valve repair is the standard therapy for patients with severe mitral regurgitation. Currently, robotic mitral valve repair is the least invasive surgical approach and an alternative to the traditional sternotomy. Recent studies and newer guidelines on mitral valve repair advocate for earlier referral to surgery, resulting in better long-term outcomes of valve function and decreased left ventricular remodeling. PURPOSE: Robotic mitral valve repair outcomes were compared with nonrobotic mitral repair outcomes through analysis of 4 recent studies, one of which was the Food and Drug Administration trial that granted approval of robotic cardiac surgery. Two studies included their own nonrobotic groups for comparison, with one comparing the robotic approach with complete sternotomy, partial sternotomy, and mini-anterolateral thoracotomy to assess all currently available techniques. CONCLUSIONS: All 4 studies showed positive outcomes including decreased need for postoperative mechanical ventilation, intensive care unit length of stay, and hospital length of stay. The studies also showed that postrepair mitral regurgitation was equivalent to that of traditional open repairs at multiple different periods after surgery. CLINICAL IMPLICATIONS: Patients should be given the option for minimally invasive robotic mitral valve repair if they have no other risk factors such as peripheral vascular disease that prevent femoral cannulation for cardiopulmonary bypass or the need for concomitant cardiac surgery such as coronary artery bypass. With the equality of robotic outcomes compared with full sternotomy valve surgery comes the need for more research into what kind of complex valve repairs can be done, which methods of repair work best with robotic techniques, whether the learning curve for robotic surgery can be shortened with more widespread use, and what outcomes can be improved upon from this standpoint. Healthcare professionals need to be aware of all choices for patients who need surgical intervention for their mitral regurgitation.
BACKGROUND: Mitral valve repair is the standard therapy for patients with severe mitral regurgitation. Currently, robotic mitral valve repair is the least invasive surgical approach and an alternative to the traditional sternotomy. Recent studies and newer guidelines on mitral valve repair advocate for earlier referral to surgery, resulting in better long-term outcomes of valve function and decreased left ventricular remodeling. PURPOSE:Robotic mitral valve repair outcomes were compared with nonrobotic mitral repair outcomes through analysis of 4 recent studies, one of which was the Food and Drug Administration trial that granted approval of robotic cardiac surgery. Two studies included their own nonrobotic groups for comparison, with one comparing the robotic approach with complete sternotomy, partial sternotomy, and mini-anterolateral thoracotomy to assess all currently available techniques. CONCLUSIONS: All 4 studies showed positive outcomes including decreased need for postoperative mechanical ventilation, intensive care unit length of stay, and hospital length of stay. The studies also showed that postrepair mitral regurgitation was equivalent to that of traditional open repairs at multiple different periods after surgery. CLINICAL IMPLICATIONS: Patients should be given the option for minimally invasive robotic mitral valve repair if they have no other risk factors such as peripheral vascular disease that prevent femoral cannulation for cardiopulmonary bypass or the need for concomitant cardiac surgery such as coronary artery bypass. With the equality of robotic outcomes compared with full sternotomy valve surgery comes the need for more research into what kind of complex valve repairs can be done, which methods of repair work best with robotic techniques, whether the learning curve for robotic surgery can be shortened with more widespread use, and what outcomes can be improved upon from this standpoint. Healthcare professionals need to be aware of all choices for patients who need surgical intervention for their mitral regurgitation.