With the incredible advances in technology, many patients can now have an even less invasive approach than Mini MVR, using the DaVinci SI robot. Robotic mitral valve repair is an ultra-minimally invasive approach performed using tiny 1 – 2 inch incisions placed between the ribs. No rib or breastbone is ever cut or broken, which usually reduces pain significantly and shortens recovery time markedly. In this procedure, tiny robotic arms and a small 3D camera are placed inside the patient’s chest between the ribs, and are controlled by the surgeon at a console 5 feet away. To be clear, in robotic heart surgery the robot is not doing the surgery; the surgeon is – just using the incredible enabling technology of the DaVinci Si robot!
Instead of the traditional full sternotomy approach which uses a 10 – 12 inch incision and the surgeon looking down into the chest and operating with his gloved hands, with the DaVinci Si, I sit at a nearby console and am immersed in an incredible magnified 3D color image of the mitral valve which can give me a better appreciation of what’s wrong with the valve and how to fix it. I control tiny robotic hands that allow me to very precisely repair what is broken inside your heart. The increased exposure of the valve and greater surgical precision can lead to a higher chance of a successful and durable mitral valve repair.
At the Cleveland Clinic, I was part of the team that performed over 1000 consecutive robotic mitral valve repairs without a single mortality. In addition, using the techniques I am now specially trained in, we were able to achieve a mitral valve repair rate of over 99%!
How does robotic mitral valve repair compare to other surgical approaches?
In a published study performed at the Cleveland Clinic:
Methods: From January 2006 to January 2009, 759 patients with degenerative mitral valve disease and posterior leaflet prolapse underwent primary isolated mitral valve surgery by complete sternotomy (n = 114), partial sternotomy (n = 270), right mini-anterolateral thoracotomy (n = 114), or a robotic approach (n = 261). Outcomes were compared on an intent-to-treat basis using propensity-score matching.
Results: Mitral valve repair was achieved in all patients except 1 patient in the complete sternotomy group. In matched groups, median cardiopulmonary bypass time was 42 minutes longer for robotic than complete sternotomy, 39 minutes longer than partial sternotomy, and 11 minutes longer than right mini-anterolateral thoracotomy (P < .0001); median myocardial ischemic time was 26 minutes longer than complete sternotomy and partial sternotomy, and 16 minutes longer than right mini-anterolateral thoracotomy (P<.0001). Quality of mitral valve repair was similar among matched groups (P = .6, .2, and .1, respectively). There were no in-hospital deaths. Neurologic, pulmonary, and renal complications were similar among groups (P>.1). The robotic group had the lowest occurrences of atrial fibrillation and pleural effusion, contributing to the shortest hospital stay (median 4.2 days), 1.0, 1.6, and 0.9 days shorter than for complete sternotomy, partial sternotomy, and right mini-anterolateral thoracotomy (all P <.001), respectively.
Conclusions: Robotic repair of posterior mitral valve leaflet prolapse is as safe and effective as conventional approaches. Technical complexity and longer operative times for robotic repair are compensated for by lesser invasiveness and shorter hospital stay.
(You can download the article here)
One of our patients 2 weeks following successful Robotic MVR
Video Clip of Robotic MVR