REPAIR OF MITRAL VALVE AND CLOSURE OF ATRIAL COMMUNICATION,

ASSISTED BY ROBOT: INITIAL EXPERIENCE

PRACTICE

III

TEACHER

LIDY HIGUERA

NAME

CARLOS ANDRES OSPINA BUENO

CODE

01220022027

HEART INSTITUTE

UNIVERSITY OF SANTANDER

SURGICAL INSTRUMENTATION

BUCARAMANGA

2023
 REPAIR OF MITRAL VALVE AND CLOSURE OF ATRIAL COMMUNICATION, ASSISTED BY
ROBOT: INITIAL EXPERIENCE

Introduction
Valvular heart surgery is a complex procedure that is usually performed using a conventional
mean sternotomy to obtain adequate exposure. However, minimally invasive techniques have
gained ground due to their favorable results, allowing surgical procedures to be performed in
smaller spaces through small incisions. In recent decades, technological advances, such as
robotic telemanipulation, have transformed heart surgery, making it more efficient and safer.

Background
This study was conducted at the Cardiovascular Surgery Department of the Las Condes Clinic
in Santiago, Chile. The aim of the study was to evaluate the short- and long-term results of
robot-assisted cardiac surgery, specifically in mitral valve (MVR) repairs and atrial septal
closure (ASD).

Methods
Patients requiring cardiac surgery due to severe mitral failure or ASD that was not susceptible
to percutaneous management were selected. The procedures were performed between
December 2015 and February 2019 using a Da Vinci SI robotic system in a general anesthetic
setting. Demographic aspects, surgical times, hours of mechanical ventilation, intensive care
and hospitalization days, morbidity and echocardiographic results were evaluated at
postoperative follow-up month.

Results
A total of 13 procedures were carried out, of which 9 were mitral valve repairs and 4 were CIA
closures. In MVR procedures, the average time of extracorporeal circulation was 120 20.9
minutes, and the average time of myocardial ischemia was 89 21 minutes. The median
mechanical ventilation was 6 hours, and the stay in the intensive care unit and hospital was 1
and 5 days, respectively. Two patients experienced prolonged hospital discharge due to
complications, one due to postoperative pneumonia and one due to comorbidities. There was no
mortality or re-operations.

In CIA cases, a bovine pericardial patch or CorMatrix extracellular matrix was used. All
patients were discharged after 4 days without complications. In the postoperative follow-up at 1
month, all patients showed improvement in their functional class (NYHA) from type II to type
I, without ultrasound signs of CIA and a decrease in pulmonary hypertension. All patients were
kept in control and follow-up, with continuous improvement and no mitral regurgitation, except
one case with mild mitral regurgitation.

Conclusions
The study concluded that minimally invasive robot-assisted cardiac surgery for mitral valve
repairs and CIA shutdown had very favorable results, comparable to the standards of minimally
invasive robot-assisted cardiac surgery centers. In addition, it was emphasized that this
technique is safe and effective, with a low morbidity and no mortality. The importance of
adequate patient selection and detailed preoperative evaluation to achieve these successful
outcomes was emphasized.
 QUESTIONS TO KNOW PRO

Question 1
What were the specific criteria used for the selection of patients with severe mitral failure or
atrial septal defect for minimally invasive robot-assisted surgery, and how was its suitability
assessed in relation to the anatomical and functional conditions of their respective cardiac
conditions?

A) The selection criteria were mainly based on the age of the patients and their comorbidity.
B) The selection criteria focused on the severity of mitral regurgitation or the size of the atrial
septal defect.
C) The selection criteria were determined solely by the preference of the surgeon.

Question 2
What were the main advantages and technical challenges associated with the use of an
incomplete flexible ring in mitral valve repairs, and how do these results compare with repair
procedures involving intracorporeal continuous suture described by Mihaljevic?

A) The advantages included increased durability and reduced risk of mitral regurgitation, while
the challenges were related to technical complexity.
B) The benefits were associated with faster postoperative recovery, while challenges were
associated with a higher rate of reoperation.
C) The advantages included a lower learning curve and shorter duration of surgery, while the
challenges were associated with a higher incidence of complications.

Question 3
In the context of minimally invasive robot-assisted cardiac surgery, were any significant
variability observed in mechanical ventilation times, days of stay in the intensive care unit or
days of hospitalization depending on the complexity of the procedure or the preoperative
characteristics of the patients?

A) No variability was observed in these parameters, since all patients had similar ventilation
and stay times in the intensive care unit.
B) Significant variability was observed in mechanical ventilation times and days of
hospitalization, but not in days of stay in the intensive care unit.
C) Variability was observed in all parameters depending on the complexity of the procedure
and the preoperative characteristics of the patients.