Echocardiographic Guided Mitral Valve Repair

Objective: To present our overall surgical outcomes of echo guided robotic assisted mitral valve repair (R-MVr).
Methods: From June 2005 to August 2016, 628 R-MVr were performed. Any patient requiring isolated MVr underwent R-MVr and received an annuloplasty band and one or more of the following: leaflet resection, chordal transposition and/or neochordal replacement. All procedures were assessed intraoperatively, pre and post R-MVr, with transesophogeal echocardiography.
Results: All 628 patients had severe mitral regurgitation (MR). Overall mean age was 61.0±11.6 years, 414 (65.9%) were male. Predominant MV pathology was: Barlow Syndrome 99 (15.8%), anterior leaflet prolapse 161 (25.6%), posterior leaflet prolapse 580 (92.4%) and ruptured chordae 387 (61.6%). Repair consisted of leaflet resection in 513 (81.7%), chordal transposition 73 (11.7%), artificial chordae 100(16.0%), edge to edge 119 (18.9%) and cleft closure 43 (6.9%). Cross clamp time was 89.7±27min. There was 1 hospital mortality (0.12%). Overall, 8 (1.3%) patients required subsequent MV replacement predominantly in the first 100 cases. Two patients had re-repair during the original procedure. Overall echocardiographic results; 98.7% had post-pump none to mild MR (86.5% none-trace), follow-up echo (1-12 months) showed overall none-trace MR in 73.7%, mild in 19.9% and 0.6% severe (>90% had none-trace and no severe MR in the last 400 cases).
Conclusions: Complications occurred early in our experience. With careful selection of patients with appropriate pathology we have progressed to include virtually any form of degenerative disease with R-MVr technology.