In the Journals

Robotic surgical mitral valve repair associated with high survival, few complications

At 5 years, patients who underwent robotic surgical mitral valve repair had a high rate of survival and low rates of complications and recurrent mitral regurgitation, according to the results of a single-center study.

“Our findings show for the first time that robotic mitral valve repair can be performed for all patients with degenerative mitral valve disease with a very high success rate, nearly 100%, and a very low chance of death, almost 0%,” Rakesh M. Suri, MD, DPhil, from the department of thoracic and cardiovascular surgery at Cleveland Clinic, said in an interview with Cardiology Today. “Moreover, we demonstrate for the first time that the durability of this procedure is excellent, and in some cases exceeds the standards established for mitral valve repair performed via an open chest approach.”

Rakesh A. Suri, MD, DPhil

Rakesh M. Suri

Suri and colleagues analyzed 487 patients (mean age, 56 years; 360 men) with severe nonischemic degenerative mitral regurgitation who underwent robotic mitral valve repair between January 2008 and January 2015 at Mayo Clinic. Forty-one percent required complex repair; their outcomes were compared with those who required simple repair.

At 5 years, there were only four deaths, for a survival rate of 99.5% (simple group, 99.4%; complex group, 99.5%; HR = 0.48; 95% CI, 0.05-4.59), Suri and colleagues found.

They also found that 97.9% of patients at 5 years had NYHA class I or II HF.

The 5-year rate of freedom from moderate to severe mitral regurgitation was 94.6% (simple group, 96.2%; complex group, 92.7%; HR = 1.36; 95% CI, 0.34-5.43), according to the researchers.

Mitral reoperation occurred in seven patients during the study period, for a 5-year rate of freedom from reoperation of 97.7% (simple group, 99.2%; complex group, 95.7%; HR = 3.35; 95% CI, 0.65-17.32), they found.

A lesson, Suri told Cardiology Today, is that complex robotic mitral valve repairs are best performed at experienced centers with multidisciplinary teams.

“Robotic mitral valve repair for the most complex cases is typically performed at two or three large heart valve centers,” he said. “A multidisciplinary team of cardiologists, surgeons, anesthesiologists and nurses is necessary to successfully perform the procedure. Robotic mitral valve repair is best performed by high-volume mitral valve surgeons utilizing the expertise of multidisciplinary teams to ensure optimal patient outcomes. Ultimately, patients benefit from the ability to return to their lives and normal daily activities quicker than was possible in the past.” – by Erik Swain

For more information:

Rakesh M. Suri, MD, DPhil, can be reached at Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave. J4-1, Cleveland, OH 44195; email: surir@ccf.org.

Disclosure: The researchers report no relevant financial disclosures.

At 5 years, patients who underwent robotic surgical mitral valve repair had a high rate of survival and low rates of complications and recurrent mitral regurgitation, according to the results of a single-center study.

“Our findings show for the first time that robotic mitral valve repair can be performed for all patients with degenerative mitral valve disease with a very high success rate, nearly 100%, and a very low chance of death, almost 0%,” Rakesh M. Suri, MD, DPhil, from the department of thoracic and cardiovascular surgery at Cleveland Clinic, said in an interview with Cardiology Today. “Moreover, we demonstrate for the first time that the durability of this procedure is excellent, and in some cases exceeds the standards established for mitral valve repair performed via an open chest approach.”

Rakesh A. Suri, MD, DPhil

Rakesh M. Suri

Suri and colleagues analyzed 487 patients (mean age, 56 years; 360 men) with severe nonischemic degenerative mitral regurgitation who underwent robotic mitral valve repair between January 2008 and January 2015 at Mayo Clinic. Forty-one percent required complex repair; their outcomes were compared with those who required simple repair.

At 5 years, there were only four deaths, for a survival rate of 99.5% (simple group, 99.4%; complex group, 99.5%; HR = 0.48; 95% CI, 0.05-4.59), Suri and colleagues found.

They also found that 97.9% of patients at 5 years had NYHA class I or II HF.

The 5-year rate of freedom from moderate to severe mitral regurgitation was 94.6% (simple group, 96.2%; complex group, 92.7%; HR = 1.36; 95% CI, 0.34-5.43), according to the researchers.

Mitral reoperation occurred in seven patients during the study period, for a 5-year rate of freedom from reoperation of 97.7% (simple group, 99.2%; complex group, 95.7%; HR = 3.35; 95% CI, 0.65-17.32), they found.

A lesson, Suri told Cardiology Today, is that complex robotic mitral valve repairs are best performed at experienced centers with multidisciplinary teams.

“Robotic mitral valve repair for the most complex cases is typically performed at two or three large heart valve centers,” he said. “A multidisciplinary team of cardiologists, surgeons, anesthesiologists and nurses is necessary to successfully perform the procedure. Robotic mitral valve repair is best performed by high-volume mitral valve surgeons utilizing the expertise of multidisciplinary teams to ensure optimal patient outcomes. Ultimately, patients benefit from the ability to return to their lives and normal daily activities quicker than was possible in the past.” – by Erik Swain

For more information:

Rakesh M. Suri, MD, DPhil, can be reached at Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, 9500 Euclid Ave. J4-1, Cleveland, OH 44195; email: surir@ccf.org.

Disclosure: The researchers report no relevant financial disclosures.