Minimally Invasive Mitral Valve Surgery
Robotic MV repair 2006 - 2012
1000
Outline • Building a program • Patient selection • Evolution of surgical techniques • Results
Outline • Building a program • Patient selection • Evolution of surgical techniques • Results
Building a Program Golden rules • Team effort • Surgical experience • Focus on quality
Outline • Building a program • Patient selection • Evolution of surgical techniques • Results
Patient Selection Myxomatous MV ECHO, Cath, Chest/ abdomen CT
Isolated MV disease
CAD, Aortic atherosclerosis, pectus anular calcifications
Robotic MV
Complete or mini sternotomy
Barlow disease
Fibroelastic deficiency
Artificial chordae/ resection
Triangular resection
Outline • Building a program • Patient selection • Evolution of surgical techniques • Results
Port Placement
Endoscopic approach
Port Placement - Pitfalls Conflict L arm vs. aortic clamp • Place clamp posteriorly
L atriotomy tear • Place arm in the 5th IC space
Poor visualization • Move working port cranially
Outline • Port placement • CPB management • Mitral valve repair techniques
Robotically-assisted Cardiac
CPB Pitfalls • Stroke •
Vascular screening
•
Minimize valve testing
•
Clamp removal in Trendelenburg
• Limb ischemia •
Minimize bypass times
•
Avoid cannulation of small vessels
Outline • Port placement • CPB management • Mitral valve repair techniques
Localized Prolapse / Flail
Barlow’s Disease
Running Annuloplasty
Bileaflet Mitral Valve Prolapse
Atriotomy and Valve Inspection
Bileaflet Repair
Outline • Building a program • Patient selection • Evolution of surgical techniques • Results
Mortality
0%
Mitral Valve Repair
99.3 %
Residual MR 90
Neochordae Resection
75 60
%
45 30 15 0
0
1+
2+
3+
4+
Ischemic Time 120
Surgeon A 100
Surgeon B 80
Min
60
50
100
150
200
Patient Number
250
Conclusions • Robotic mitral valve repair is a safe and effective approach for majority of patients with myxomatous mitral valve disease
Thank You