Background: Robotic mitral valve (MV) repairs have become standard at many institutions, owing to excellent early results. Repair failures have been attributed to the challenging technology, a learning curve, and potentially to the use of U-clips for anchoring the MV annuloplasty band instead of braided sutures. The purpose of this study was to determine causes of robotic MV repair failure and develop methods to obviate these failures.
Methods: A total of 300 patients underwent a daVinci ™ robotic MV repair between May of 2000 and November of 2006 at our institution and all were done by single operating console surgeon. Partial annuloplasty bands (Cosgrove annuloplasty band™) were used in every case. Clinical data in patients requiring a later re-operation, as well as videos of their original operation were reviewed. From these data the type of MV dysfunction, type of repair, and findings at the reoperation were determined.
Results: Of the group 15 (5%) patients required a reoperation. Seven (7%) of these failures occurred in first 100 cases with the other 8 (4%) during the last 200 cases. Initial MV pathology included isolated anterior or posterior leaflet prolapse (n=6 in each group) or bileaflet prolapse (n=3). Reoperations were required early (< 6 months) in 7 patients and after 6 months in 8 patients from their initial operation. Reasons for reoperation included: CHF (n=9), hemolysis (n=3), systolic anterior leaflet motion (n=2), and endocarditis (n=1). At reoperation, 6 patients had partial dehiscence of the annuloplasty band. U-clips were not associated with a higher incidence of band dehiscence. Clearly, band failure decreased with the learning curve.
Conclusion: Re-operative rates decrease considerably with increased case experience and surgeon robotic skill and are similar to those of MV repairs using conventional surgical techniques. The use of U-clips is not associated with a higher rate of reoperation.