Continued follow-up of the free margin running suture technique for mitral repair

A mitral valve repair update: simple, intuitive and physiological techniques, using running sutures (part I)

Today's mitral valve techniques are pluralistic, and the result of variable contributions over decades. However, they are often associated with subjectivity, and inter-surgeon variability, as well as differing outcomes. Here, we propose a set of conceptual techniques, which aim to simplify and standardize mitral valve repair, of which some we have already verified in practice.

Evaluation of robotic-assisted mitral surgery in a contemporary experience

AIMS

To evaluate the safety/effectiveness of a recently established robotic-assisted mitral surgery program.

METHODS

Cohort study with prospective collection of clinical data of 59 consecutive recipients (May 2019-August 2021) of robotic-assisted (fourth-generation platform, DaVinci X) mitral valve repair for degenerative disease, using a totally endoscopic technique. Patients' selection was based on defined anatomical and clinical criteria. We established a dedicated multidisciplinary protocol to facilitate postoperative fast-tracking, and a systematic in-house clinical and echocardiographic follow-up at 3, 6, and 12 postoperative months.

RESULTS

All patients (89.8% men, average age 58 ± 12 years) received mitral valve repair; there was no operative mortality, one conversion to sternotomy (1.7%) and one stroke (1.7%). Extubation within the operative theater occurred in 28.8%; average mechanical ventilation time and ICU stay was 2.8 ± 4.1 and 32.5 ± 15.8 h (after exclusion of one outlier, learning-curve period, suffering from perioperative stroke); average postoperative hospital stay was 6.8 ± 3.4 days and 96.6% of patients were discharged home. One patient was transfused (1.7%); there were no other complications. Follow-up revealed stability of the results of mitral repair, with one (1.7%) persistent (>2+/4+) mitral regurgitation, and stability of coaptation height over time. We observed optimal functional results (class I was 98% at 3 months and 96% at 12 months). Quarterly case load consistently increased during the experience.

CONCLUSION

This initial experience suggests the reliability and clinical safety of a recently established local robotic-assisted mitral surgery. This strategy can facilitate faster postoperative recovery, and its positioning in the therapeutic armamentarium needs to be defined.