Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital

doi:10.1093/ejcts/ezy134

. 2018 Nov 1;54(5):853-859.

doi: 10.1093/ejcts/ezy134.

Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital

Chia-Cheng Kuo^{1

2

3}, Hsiao-Huang Chang^{2

4}, Chung-Hsi Hsing^{5

6}, Hiong-Ping Hii¹, Nan-Chun Wu¹, Chin-Ming Hsu¹, Chun-I Chen¹, Bor-Chih Cheng^{1

7}

Affiliations

¹ Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
² Division of Cardiovascular Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan.
³ Department of Surgery, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
⁴ Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan.
⁵ Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
⁶ Department of Anesthesiology, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁷ Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.

PMID: 29617931
PMCID: PMC6191928
DOI: 10.1093/ejcts/ezy134

Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital

Chia-Cheng Kuo et al. Eur J Cardiothorac Surg. 2018.

. 2018 Nov 1;54(5):853-859.

doi: 10.1093/ejcts/ezy134.

Authors

Chia-Cheng Kuo^{1

2

3}, Hsiao-Huang Chang^{2

4}, Chung-Hsi Hsing^{5

6}, Hiong-Ping Hii¹, Nan-Chun Wu¹, Chin-Ming Hsu¹, Chun-I Chen¹, Bor-Chih Cheng^{1

7}

Affiliations

¹ Division of Cardiovascular Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.
² Division of Cardiovascular Surgery, Department of Surgery, Taipei Veteran General Hospital, Taipei, Taiwan.
³ Department of Surgery, School of Medicine, National Defense Medical Center, Taipei, Taiwan.
⁴ Department of Surgery, School of Medicine, Taipei Medical University, Taipei, Taiwan.
⁵ Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan.
⁶ Department of Anesthesiology, College of Medicine, Taipei Medical University, Taipei, Taiwan.
⁷ Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.

PMID: 29617931
PMCID: PMC6191928
DOI: 10.1093/ejcts/ezy134

Erratum in

Corrigendum to: 'Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital' [Eur J Cardiothorac Surg 2018;54:853--9].
Kuo CC, Chang HH, Hsing CH, Hii HP, Wu NC, Hsu CM, Chen CI, Cheng BC. Kuo CC, et al. Eur J Cardiothorac Surg. 2018 Nov 1;54(5):967. doi: 10.1093/ejcts/ezy299. Eur J Cardiothorac Surg. 2018. PMID: 30102320 Free PMC article. No abstract available.

Abstract

Objectives: Robotic mitral valve replacement (MVR) emerged in the late 1990s as an alternative approach to conventional sternotomy. With the increased use of bioprosthetic valves worldwide and strong patient desire for minimally invasive procedures, the safety and feasibility of robotic MVRs with bioprosthetic valves require investigation.

Methods: Between January 2013 and May 2017, 52 consecutive patients underwent robotic MVRs using the da Vinci Si surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA). Their mean age was 55.1 ± 13.8 years, and mean EuroSCORE II was 2.25% ± 1.25%. Among the enrolled patients, 32 (61.5%) patients presented with preoperative atrial fibrillation, 6 (11.5%) patients had experienced embolic stroke and 5 (9.6%) patients had undergone previous cardiac surgery. The operations were performed using cardiopulmonary bypass (CPB) under an arrested heart status.

Results: Five porcine valves and 47 bovine valves were implanted. A total of 38 (73.1%) patients received concomitant cardiac procedures, including 26 Cox-maze IV procedures, 12 tricuspid valve repairs and 5 atrial septal defect repairs. The mean aortic cross-clamp and CPB times were 141.3 ± 34.3 min and 217.1 ± 42.0 min, respectively. There was no operative mortality. During the mean follow-up of 29 ± 15 months, no prosthesis degeneration was noted. The average left atrial dimension exhibited a significant decrease from 51.4 ± 11.5 mm to 42.6 ± 10.1 mm.

Conclusions: Robotic MVR with bioprosthetic valves is safe, feasible and reproducible. Mid-term results are encouraging. Both aortic cross-clamp and CPB times can be improved with experience.

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Figures

**Figure 1:**
External view. (A) A set-up for robotic mitral valve replacement, including robot arm ports and rib retractor for working port. (B) Mitral prosthesis deployment through a rib retractor.

**Figure 2:**
An intracavitary pacing wire is fixed into the left ventricular endocardium and placed between the annulus and suture ring of the prosthesis.

**Figure 3:**
Exponential regression curve for changes in (A) aortic cross-clamp time and (B) cardiopulmonary bypass time according to the chronological data for robotic MVRs. Aortic cross-clamp time: y (min) = 210.14x^−0.142; r² = 0.297; P <0.001 and cardiopulmonary bypass time: y (min) = 320.6x^−0.136; r² = 0.417; P <0.001. MVR: mitral valve replacement.

See this image and copyright information in PMC

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References

1. Roffi M, Alfieri O, Agewall S, Ahlsson A, Barbato E, Bueno H. et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739–91. - PubMed
1. Gammie JS, Sheng S, Griffith BP, Peterson ED, Rankin JS, O'Brien SM. et al. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Database. Ann Thorac Surg 2009;87:1431–9. - PubMed
1. Chikwe J, Chiang YP, Egorova NN, Itagaki S, Adams DH.. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. JAMA 2015;313:1435–42. - PubMed
1. Kaneko T, Aranki S, Javed Q, McGurk S, Shekar P, Davidson M. et al. Mechanical versus bioprosthetic mitral valve replacement in patients <65 years old. J Thorac Cardiovasc Surg 2014;147:117–26. - PubMed
1. Bourguignon T, Espitalier F, Pantaleon C, Vermes E, El-Arid JM, Loardi C. et al. Bioprosthetic mitral valve replacement in patients aged 65 years or younger: long-term outcomes with the Carpentier–Edwards PERIMOUNT pericardial valve. Eur J Cardiothorac Surg 2018;54:302--9. - PubMed

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[1] Roffi M, Alfieri O, Agewall S, Ahlsson A, Barbato E, Bueno H. et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739–91. - PubMed

[2] Roffi M, Alfieri O, Agewall S, Ahlsson A, Barbato E, Bueno H. et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2017;38:2739–91. - PubMed

[3] Gammie JS, Sheng S, Griffith BP, Peterson ED, Rankin JS, O'Brien SM. et al. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Database. Ann Thorac Surg 2009;87:1431–9. - PubMed

[4] Gammie JS, Sheng S, Griffith BP, Peterson ED, Rankin JS, O'Brien SM. et al. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons Adult Cardiac Database. Ann Thorac Surg 2009;87:1431–9. - PubMed

[5] Chikwe J, Chiang YP, Egorova NN, Itagaki S, Adams DH.. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. JAMA 2015;313:1435–42. - PubMed

[6] Chikwe J, Chiang YP, Egorova NN, Itagaki S, Adams DH.. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. JAMA 2015;313:1435–42. - PubMed

[7] Kaneko T, Aranki S, Javed Q, McGurk S, Shekar P, Davidson M. et al. Mechanical versus bioprosthetic mitral valve replacement in patients <65 years old. J Thorac Cardiovasc Surg 2014;147:117–26. - PubMed

[8] Kaneko T, Aranki S, Javed Q, McGurk S, Shekar P, Davidson M. et al. Mechanical versus bioprosthetic mitral valve replacement in patients <65 years old. J Thorac Cardiovasc Surg 2014;147:117–26. - PubMed

[9] Bourguignon T, Espitalier F, Pantaleon C, Vermes E, El-Arid JM, Loardi C. et al. Bioprosthetic mitral valve replacement in patients aged 65 years or younger: long-term outcomes with the Carpentier–Edwards PERIMOUNT pericardial valve. Eur J Cardiothorac Surg 2018;54:302--9. - PubMed

[10] Bourguignon T, Espitalier F, Pantaleon C, Vermes E, El-Arid JM, Loardi C. et al. Bioprosthetic mitral valve replacement in patients aged 65 years or younger: long-term outcomes with the Carpentier–Edwards PERIMOUNT pericardial valve. Eur J Cardiothorac Surg 2018;54:302--9. - PubMed

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Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital

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Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital

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