Douglas A Murphy1, Emmanuel Moss2, Jeffrey Miller3, Michael E Halkos3. 1. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. Electronic address: douglas.murphy@emory.edu. 2. Division of Cardiac Surgery, Jewish General Hospital, McGill University, Montreal, Quebec, Canada. 3. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Abstract
BACKGROUND: Mitral valve reoperation is necessary in a finite percentage of patients. With growth in robotic mitral valve operations, reoperative strategies need to be developed. A review of institutional mitral valve reoperations after a previous robotic approach was undertaken. METHODS: From January 2006 through April 2017, 1,853 patients underwent an initial robotic mitral valve operation by a dedicated robotic team. During this interval, 54 of these patients (2.9%) required mitral reoperation at our institution. The prospectively collected operative, echocardiographic, videoscopic, and outcome data for these patients were retrospectively reviewed to assess the feasibility, efficacy, and safety of a repeat robotic mitral valve operation. RESULTS: Reoperative mitral operation after a previous robotic procedure was completed robotically in 50 patients (92.6%). Robotic mitral re-repair was achieved in 36 of the 50 patients (72%), including 33 of the 39 patients (85%) with degenerative disease. Conversion of a previous repair to a replacement was performed in 12 patients (24%) and re-replacement in 2 patients (4%). No patients were converted from a robotic approach to a thoracotomy or sternotomy approach. There were no deaths or strokes in this series. Major morbidity occurred in 1 patient (2%) in the repeat robotic group. Sternotomy for reoperation was required in 4 patients (7%) due to right chest access or peripheral perfusion limitations. CONCLUSIONS: Repeat robotic mitral operation after a previous robotic approach is feasible and appears to be an effective and safe strategy in a high percentage of patients when performed by an experienced robotic team.
BACKGROUND: Mitral valve reoperation is necessary in a finite percentage of patients. With growth in robotic mitral valve operations, reoperative strategies need to be developed. A review of institutional mitral valve reoperations after a previous robotic approach was undertaken. METHODS: From January 2006 through April 2017, 1,853 patients underwent an initial robotic mitral valve operation by a dedicated robotic team. During this interval, 54 of these patients (2.9%) required mitral reoperation at our institution. The prospectively collected operative, echocardiographic, videoscopic, and outcome data for these patients were retrospectively reviewed to assess the feasibility, efficacy, and safety of a repeat robotic mitral valve operation. RESULTS: Reoperative mitral operation after a previous robotic procedure was completed robotically in 50 patients (92.6%). Robotic mitral re-repair was achieved in 36 of the 50 patients (72%), including 33 of the 39 patients (85%) with degenerative disease. Conversion of a previous repair to a replacement was performed in 12 patients (24%) and re-replacement in 2 patients (4%). No patients were converted from a robotic approach to a thoracotomy or sternotomy approach. There were no deaths or strokes in this series. Major morbidity occurred in 1 patient (2%) in the repeat robotic group. Sternotomy for reoperation was required in 4 patients (7%) due to right chest access or peripheral perfusion limitations. CONCLUSIONS:Repeat robotic mitral operation after a previous robotic approach is feasible and appears to be an effective and safe strategy in a high percentage of patients when performed by an experienced robotic team.
Authors: Talia G Meidan; Allison T Lanfear; John J Squiers; Mohanad Hamandi; Bruce W Lytle; J Michael DiMaio; Robert L Smith Journal: JTCVS Tech Date: 2022-02-24