Robotic mitral valve repair: Experience with the da Vinci system

L. Wiley Nifong, Victor F. Chu, B. Marcus Bailey, David M. Maziarz, Vincent L. Sorrell, Donald Holbert, Randolph R. Chitwood, Craig R. Smith

Research output: Contribution to journalArticlepeer-review

164 Scopus citations

Abstract

Background. As part of a Food and Drug Administration trial, mitral repairs were performed in 38 patients using the robotic da Vinci surgical system (Intuitive Surgical, Inc, Mountain View, CA). Prospectively, we evaluated safety and efficacy in performing both simple and complex mitral repairs. Methods. Eligible patients had nonischemic moderate to severe mitral insufficiency. Operative techniques included peripheral cardiopulmonary perfusion, a 4- to 5-cm mini-thoracotomy, transthoracic aortic occlusion, and antegrade blood cardioplegia. Transesophageal echocardiograms were done intraoperatively with three-dimensional reconstructions. Successful repairs were defined as mild or less residual regurgitation. Results. Enhanced three-dimensional visualization of mitral leaflets and the subvalvar apparatus allowed safe, dexterous intracardiac tissue manipulation. All patients had successful valve repairs including quadrangular resections, sliding plasties, and edge-to-edge approximations, as well as both chordal transfers and replacements. There were no operative deaths, strokes, or device-related complications. One patient required valve replacement for hemolysis and 1 was reexplored for bleeding. There were no incisional conversions. Both robotic repair and total operating times decreased significantly from 1.9 ± 0.1 and 5.1 ± 0.1 hours (mean ± standard error of the mean) for the first 19 patients to 1.5 ± 0.1 (p = 0.002) and 4.4 ± 0.1 hours (p = 0.04) for the last 19 operations, respectively. Total hospital length of stay for patients was 3.8 ± 0.6 days. Of all patients, 31 (82%) had a 4-day or less length of stay. Seven patients (18%) had stays between 5 and 9 days (6.4 ± 1.0). Conclusions. This study shows that the da Vinci surgical system (Intuitive Surgical, Inc) has few limitations in performing complex valve repairs. Articulated wrist-like instruments and three-dimensional visualization enabled precise tissue telemanipulation. Future robotic design advances and adjunctive suture technologies may promote continuing evolution of robotic cardiac operations.

Original languageEnglish
Pages (from-to)438-443
Number of pages6
JournalAnnals of Thoracic Surgery
Volume75
Issue number2
DOIs
StatePublished - Feb 1 2003

Bibliographical note

Funding Information:
This work was supported by the Innovation in Clinical Research Award (Grant No. 1059) from the Doris Duke Charitable Foundation (New York City, NY).

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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