Early experience with robotic mitral valve repair with intra-aortic occlusion.

OBJECTIVE: To report the learning curve and early results of robotic mitral valve repairs in comparison with propensity score-matched sternotomy controls after the adoption of a robotic mitral valve surgery program in a university teaching hospital. METHODS: A total of 142 patients underwent robotic mitral valve repair due to degenerative mitral regurgitation between May 2011 and December 2015. Control patients operated on via the conventional sternotomy approach were selected by the use of propensity score analysis resulting in 2 well-matched study groups. RESULTS: Valve repair rate was 98.6% and 97.9% in the robotic and sternotomy groups, respectively. Operation length, cardiopulmonary bypass, aortic crossclamp, and ventilation times were shorter in the sternotomy group. All of these times were statistically significantly reduced within the robotic group during the learning curve. Even though there was no statistically significant difference in the rate of perioperative complications between the groups, 3 patients in the robotic group required postoperative extracorporeal membrane oxygenation due to low cardiac output, and 1 patient in the robotic group died. In the robotic and sternotomy groups, 86.3% versus 84.7% of patients had grade ≤1+ mitral valve regurgitation at the latest follow-up visit, and there was no statistically significant difference in survival or reoperation rate between the 2 study groups during follow-up. CONCLUSIONS: The present series reports the entire early learning curve related to the introduction of robotic mitral valve repair in our institution. In all, repair rate and early durability were acceptable, but more patients in the robotic group had serious complications. Early major robotic complications that occurred may have been related to the simultaneous use of intra-aortic occlusion.

Quality of life after robotically assisted atrial myxoma excision.

The aim of this study was to evaluate the clinical outcome after robotically assisted myxoma surgery performed at our institution. Altogether nine patients underwent robotically assisted atrial myxoma excision. A control group was selected from 18 consecutive patients who underwent an isolated atrial myxoma excision via conventional sternotomy. Preoperative patient characteristics were similar between the two study groups. Postoperative health-related quality of life (HRQoL) was also evaluated. All robotic operations were completed successfully using the da Vinci™ telesurgical system. There was no mortality in either of the two study groups. Procedure, cardiopulmonary bypass, aortic occlusion, and ventilation times were shorter in the sternotomy group when compared to the robotic group. Length of stay was statistically significantly shorter in the robotically assisted group. Postoperative quality of life did not differ between the two study groups. We conclude that robotically assisted surgery is a feasible method for treating atrial myxomas.

Transaortic valve-in-valve implantation after previous aortic root homograft.

Catheter-based valve implantation techniques are becoming a viable option in various clinical situations to replace difficult redo open heart surgical procedures. This is a report of a first, to our knowledge, successful valve-in-valve (VinV) transcatheter aortic valve implantation (TAVI) into a homograft through the transaortic (TAo) access route using an Edwards SAPIEN valve prosthesis (Edwards Lifesciences, LLC, Irvine, CA) in a patient with poor left ventricular function and generalized severe atherosclerosis.

Microwave Ablation in Mitral Valve Surgery for Atrial Fibrillation (MAMA).

Objective: Microwave ablation in conjunction with open heart surgery is effective in restoring sinus rhythm (SR) in patients with atrial fibrillation (AF). In patients assigned for isolated mitral valve surgery no prospective randomized trial has reported its efficacy. Methods: 70 patients with longlasting AF where included from 5 different centres. They were randomly assigned to mitral valve surgery and atrial microwave ablation or mitral valve surgery alone. Results: Out of 70 randomized, 66 and 64 patients were available for evaluation at 6 and 12 months. At 12 months SR was restored and preserved in 71.0 % in the ablation group vs 36.4 % in the control group (P=0.006), corresponding figures at 6 months was 62.5 % vs 26.5 % (P=0.003). The 30-day mortality rate was 1.4 %, with one death in the ablation group vs zero deaths in the control group. At 12 months the mortality rate was 7,1 % (Ablation n=3 vs Control n=2). No significant differences existed between the groups with regard to the overall rate of serious adverse events (SAE) during the perioperative period or at the end of the study. 16 % of patients randomized to ablation were on antiarrhytmic drugs compared to 6 % in the control group after 1 year (p=0.22). Conclusion: Microwave ablation of left and right atrium in conjunction with mitral valve surgery is safe and effectively restores sinus rhythm in patients with longlasting AF as compared to mitral valve surgery alone.