The Journal of Thoracic and Cardiovascular Surgery
Adult: Mitral Valve: Evolving TechnologyA conservative screening algorithm to determine candidacy for robotic mitral valve surgery
Graphical abstract
A conservative screening algorithm for selection of candidates for robotic mitral valve surgery. Preoperative echocardiography and computed tomographic scanning are used to identify patients with isolated degenerative mitral valve disease who are candidates for a robotic approach. Numbers indicate the numbers of patients with preoperative findings that led to exclusion from the robotic approach.
Section snippets
Patients and Methods
From January 2014 to January 2019, 1000 consecutive patients with isolated degenerative mitral valve disease underwent mitral valve surgery by 1 of 3 surgeons with expertise in both robotic and sternotomy-based approaches. These surgeons did not perform mitral valve repair via right thoracotomy without robotic assistance. During this time frame, the 3 surgeons adopted a uniform approach to mitral valve repair, and they all agreed to rigorous application of the preoperative screening algorithm
Screening and Eligibility for Robotic Surgery
The screening algorithm was applied to 1000 consecutive patients scheduled for surgical treatment of isolated degenerative mitral regurgitation; 605 (60%) met the criteria for robotic surgery, and the remaining 395 (40%) underwent a sternotomy. Echocardiographic findings leading to a sternal approach included greater-than-mild aortic regurgitation in 26%, moderate or severe MAC in 21%, left ventricular dysfunction in 32%, and severe pulmonary hypertension in 2.3% (Table 1 and Figure 2).
Principal Findings
After application of our conservative screening algorithm, 60% of patients with isolated degenerative mitral valve disease met echocardiographic and CT criteria for robotic surgery. The most common reasons precluding a robotic approach were aortoiliac atherosclerosis, small femoral arteries, greater-than-mild aortic regurgitation, moderate or more MAC, and left ventricular dysfunction. Patients who underwent robotic surgery were younger and had fewer preoperative comorbidities than those
Conclusions
With this conservative screening algorithm, 60% of patients with isolated degenerative mitral valve disease qualified for robotic surgery. Postoperative outcomes were excellent and comparable for robotic and sternotomy-based approaches, validating the application of this screening algorithm to select candidates for robotic mitral valve surgery. This screening algorithm illustrates one approach to choosing patients for robotic mitral valve surgery, but it should not be used to limit the
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This study was funded in part by the Judith Dion Pyle Chair in Heart Valve Research, held by Dr Gillinov.
The Cardiac Robotic Surgery Working Group members are listed at end of article.
Dr Mick is now at New York Presbyterian Hospital Weill Cornell Medicine, New York, NY.