Robotically Assisted Repair of Partial Atrioventricular Canal Defect

The feasibility of robotic-assisted concomitant procedures during mitral valve operations

BACKGROUND

In this study, we present our clinical experience and midterm results with the robotic-assisted concomitant procedures during mitral valve operations.

METHODS

Between March 2010 and February 2018, a total of 34 patients (8 males, 26 females; mean age 58.3 years; range, 34 to 78 years) who underwent robotic-assisted concomitant procedures during mitral valve surgery were retrospectively analyzed. Demographic characteristics of the patients, comorbidities, medical, and surgical histories, operative and laboratory results, electrocardiographic findings, postoperative intensive care unit and ward outcomes, and cardiac follow-up data were recorded. Atrial fibrillation-related medication use, stroke, or other thromboembolic events, and electrocardiographic reports in patients who underwent cryoablation were reviewed at three and 12 months after the operation.

RESULTS

A total of 76 robotic-assisted concomitant procedures were performed during mitral valve repair (n=11) or replacement (n=23) in 34 patients. These procedures were cryoablation (n=29), tricuspid valve repair (n=6), tricuspid valve replacement (n=2), left atrial appendage ligation (n=32), atrial septal defect and patent foramen ovale closure (n=5), and left atrial thrombectomy (n=2). The mean preoperative EuroSCORE values were 5.1±2.5. The mean duration of cardiopulmonary bypass and cross-clamp was 156±69.4 min and 101±42 min, respectively. Normal sinus rhythm was restored in 85% of the patients (24/28) after cryoablation and two patients (5.8%) had permanent pacemaker within a year during follow-up. There was one (2.9%) mortality in the early postoperative period due to hemorrhage related to the posterior left ventricular wall rupture. No blood product was used in 82.4% of the patients. One patient had a transient cerebral event and symptoms regressed completely within two months.

CONCLUSION

Technological improvements and growing experience can decrease the suspects related to prolonged operational duration during robotic-assisted cardiac surgery. Concomitant procedures in addition to mitral valve operations can be performed with low complication rates in centers with experience of robotic surgery.

Robotic Mitral Valve Surgey Combined with Left Atrial Reduction and Ablation Procedures

INTRODUCTION

This study aimed to evaluate the feasibility and efficacy of robotically assisted, minimally invasive mitral valve surgery combined with left atrial reduction for mitral valve surgery and elimination of atrial fibrillation (AF).

METHODS

Eleven patients with severe mitral regurgitation, AF, and left atrial enlargement who underwent robotic, minimally invasive surgery between May 2013 and March 2018 were evaluated retrospectively. The da Vinci robotic system was used in all procedures. The patients' demographic data, electrocardiography (ECG) findings, and pre- and postoperative transthoracic echocardiography findings were analyzed. During follow up ECG was performed at postoperative 3, 6, and 12 months additionally at the 3rd month trans thoracic echocardiography was performed and functional capacity was also evaluated for all patients.

RESULTS

All patients underwent robotic-assisted mitral valve surgery with radiofrequency ablation and left atrial reduction. Mean age was 45.76±16.61 years; 7 patients were male and 4 were female. Preoperatively, mean left atrial volume index (LAVI) was 69.55±4.87 mL/m2, ejection fraction (EF) was 54.62±8.27%, and pulmonary artery pressure (PAP) was 45.75±9.42 mmHg. Postoperatively, in hospital evaluation LAVI decreased to 48.01±4.91 mL/m2 (P=0.008), EF to 50.63±10.13% (P>0.05), and PAP to 39.02±3.11 mmHg (P=0.012). AF was eliminated in 8 (72%) of the 11 patients at the 1st postoperative month. There were significant improvements in functional capacity and no mortality during follow-up.

CONCLUSION

Left atrial reduction and radiofrequency ablation concomitant with robotically assisted minimally invasive mitral valve surgery can be performed safely and effectively to eliminate AF and prevent recurrence.