A Marc Gillinov1, Tomislav Mihaljevic2, Hoda Javadikasgari2, Rakesh M Suri2, Stephanie L Mick2, José L Navia2, Milind Y Desai3, Johannes Bonatti2, Mitra Khosravi2, Jay J Idrees2, Ashley M Lowry4, Eugene H Blackstone5, Lars G Svensson2. 1. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. Electronic address: gillinom@ccf.org. 2. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 3. Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio. 4. Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio. 5. Department of Thoracic and Cardiovascular Surgery, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio; Quantitative Health Sciences, Research Institute, Cleveland Clinic, Cleveland, Ohio.
Abstract
OBJECTIVE: The study objective was to assess the technical and process improvement and clinical outcomes of robotic mitral valve surgery by examining the first 1000 cases performed in a tertiary care center. METHODS: We reviewed the first 1000 patients (mean age, 56 ± 10 years) undergoing robotic primary mitral valve surgery, including concomitant procedures (n = 185), from January 2006 to November 2013. Mitral valve disease cause was degenerative (n = 960, 96%), endocarditis (n = 26, 2.6%), rheumatic (n = 10, 1.0%), ischemic (n = 3, 0.3%), and fibroelastoma (n = 1, 0.1%). All procedures were performed via right chest access with femoral perfusion for cardiopulmonary bypass. RESULTS: Mitral valve repair was attempted in 997 patients (2 planned replacements and 1 resection of fibroelastoma), 992 (99.5%) of whom underwent valve repair, and 5 (0.5%) of whom underwent valve replacement. Intraoperative postrepair echocardiography showed that 99.7% of patients receiving repair (989/992) left the operating room with no or mild mitral regurgitation, and predischarge echocardiography showed that mitral regurgitation remained mild or less in 97.9% of patients (915/935). There was 1 hospital death (0.1%), and 14 patients (1.4%) experienced a stroke; stroke risk declined from 2% in the first 500 patients to 0.8% in the second 500 patients. Over the course of the experience, myocardial ischemic and cardiopulmonary bypass times (P < .0001), transfusion (P = .003), and intensive care unit and postoperative lengths of stay (P < .05) decreased. CONCLUSIONS: Robotic mitral valve surgery is associated with a high likelihood of valve repair and low operative mortality and morbidity. The combination of algorithm-driven patient selection and increased experience enhanced clinical outcomes and procedural efficiency.
OBJECTIVE: The study objective was to assess the technical and process improvement and clinical outcomes of robotic mitral valve surgery by examining the first 1000 cases performed in a tertiary care center. METHODS: We reviewed the first 1000 patients (mean age, 56 ± 10 years) undergoing robotic primary mitral valve surgery, including concomitant procedures (n = 185), from January 2006 to November 2013. Mitral valve disease cause was degenerative (n = 960, 96%), endocarditis (n = 26, 2.6%), rheumatic (n = 10, 1.0%), ischemic (n = 3, 0.3%), and fibroelastoma (n = 1, 0.1%). All procedures were performed via right chest access with femoral perfusion for cardiopulmonary bypass. RESULTS: Mitral valve repair was attempted in 997 patients (2 planned replacements and 1 resection of fibroelastoma), 992 (99.5%) of whom underwent valve repair, and 5 (0.5%) of whom underwent valve replacement. Intraoperative postrepair echocardiography showed that 99.7% of patients receiving repair (989/992) left the operating room with no or mild mitral regurgitation, and predischarge echocardiography showed that mitral regurgitation remained mild or less in 97.9% of patients (915/935). There was 1 hospital death (0.1%), and 14 patients (1.4%) experienced a stroke; stroke risk declined from 2% in the first 500 patients to 0.8% in the second 500 patients. Over the course of the experience, myocardial ischemic and cardiopulmonary bypass times (P < .0001), transfusion (P = .003), and intensive care unit and postoperative lengths of stay (P < .05) decreased. CONCLUSIONS:Robotic mitral valve surgery is associated with a high likelihood of valve repair and low operative mortality and morbidity. The combination of algorithm-driven patient selection and increased experience enhanced clinical outcomes and procedural efficiency.
Authors: Robert B Hawkins; J Hunter Mehaffey; Matthew G Mullen; Wiley L Nifong; W Randolph Chitwood; Marc R Katz; Mohammed A Quader; Andy C Kiser; Alan M Speir; Gorav Ailawadi Journal: Heart Date: 2018-06-18 Impact factor: 5.994
Authors: Ahmet Ümit Güllü; Şahin Şenay; Muharrem Koçyiğit; Eyüp Murat Ökten; Mert Dumantepe; Hasan Karabulut; Cem Alhan Journal: Turk Gogus Kalp Damar Cerrahisi Derg Date: 2019-10-23 Impact factor: 0.332
Authors: David Messika-Zeitoun; Pascal Candolfi; Maurice Enriquez-Sarano; Ian G Burwash; Vincent Chan; Jean-Francois Philippon; Jean-Manuel Toussaint; Partrick Verta; Ted E Feldman; Bernard Iung; David Glineur; Jean-Francois Obadia; Alec Vahanian; Thierry Mesana Journal: Open Heart Date: 2020-08