Robotic Mitral Valve Repair: Indication for Surgery Does Not Influence Early Outcomes.

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From: Mayo Clinic Proceedings(Vol. 94, Issue 11)
Publisher: Elsevier, Inc.
Document Type: Article
Length: 3,536 words
Lexile Measure: 1520L

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Abstract

Objective: To evaluate the outcomes of robotic mitral valve repair (MVr) by primary indication per American Heart Association guidelines for surgery: class I vs class IIa.

Patients and Methods: From January 1, 2008, through September 30, 2016, 603 patients underwent robotic MVr for severe primary mitral regurgitation. Medical records of 576 consenting patients were retrospectively reviewed to determine the primary indication for surgery. Patients were stratified into class I or class IIa, and preoperative, intraoperative, and postoperative variables were compared.

Results: Of 516 patients, 428 (83%) had class I indication and 88 (17%) had class IIa indication for surgery. Preoperatively, no significant differences were observed between both cohorts. Importantly, a significantly higher number of patients with class I indication underwent MVr for bileaflet prolapse (172 of 428 [40%] vs 21 of 88 [25%]; P=.03). Early MVr outcomes indicated recurrent mitral regurgitation (moderate or greater) in only 12 of 576 (2%), and no significant differences were observed between classes (P=.23). Apart from parameters for ventricular size, all other intraoperative and postoperative variables were comparable between both cohorts.

Conclusion: Comparable outcomes were indicated across all classes of indications for MVr surgery. These results continue to support the use of this surgical technique, even in less sick patients. Early referral along with more extensive robotic MVr experience will likely result in further improvements in long-term outcomes.

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Mitral regurgitation (MR) is the most common valve disease in Western countries, (1) and the most frequent etiology is degenerative mitral valve (MV) disease (fibroelastic deficiency or myxomatous degeneration), leading to mitral prolapse. In patients with severe regurgitation, surgical correction of the mitral valve is indicated, as disease progresses rapidly and can lead to heart failure. The current guidelines recommend surgical intervention for symptomatic patients as well as asymptomatic patients with left ventricular (LV) dysfunction, described as left ventricular ejection fraction (LVEF) less than 60% or LV dilation (LV end-systolic diameter >40-45 mm), and asymptomatic patients with normal LVEF, no LV dilation, and the likelihood of successful repair more than 95% and expected mortality less than 1%. (2,3)

Currently, surgical MV repair (MVr) is the criterion standard for degenerative disease and has excellent outcomes in terms of survival, freedom from recurrent severe MR, and freedom from reoperation. (4) Operative techniques for MVr have evolved over the past decades, and robotically assisted repair has emerged as a valuable and effective approach in experienced quaternary centers. Advantages of robotic mitral valve repair (rMVr) include smaller incisions, shorter length of stay, and potentially higher technical precision.

At our institution, the robotically assisted minimally invasive MVr program was established in 2008, and we have performed more than 600 cases with excellent reported outcomes. (5,6) However, uncertainties persist regarding the efficacy of the robotic technique in less sick patients. Mitral valve repair in patients with little to no symptoms mandates the ability to ensure a highly reproducible intervention with a high reparability rate. We proposed to understand and define outcomes in all groups of patients approached for MVr. With the...

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Gale Document Number: GALE|A609009223