Robotic mitral valve repairs requiring reoperations

: Robotic mitral valve (MV) repairs are performed at many institutions. Repair failures have been attributed to the challenging technology and potentially to the use of annuloplasty band anchoring U-clips. The purpose of this study was to characterize causes of robotic MV repair failure.

: A total of 300 patients underwent a da Vinci robotic MV repair between May 2000 and November 2006 by a single operating console surgeon. Standard repair techniques and a Cosgrove annuloplasty band were used in every case. Clinical data in patients requiring a reoperation, as well as videos of their original operation, were reviewed. MV pathology, repair methods, and findings at reoperation were determined.

: Sixteen (5.3%) patients required reoperation. Seven (7%) failures occurred in the first 100 cases and 9 (4.5%) in the last 200 cases. Initial MV pathology included isolated anterior (n = 4) or posterior leaflet prolapse (n = 6), bileaflet prolapse (n = 3), and annular dilation (n = 3). Reoperations after their initial operation were required early (<6 months) in 8 patients and later in 8 patients. Reasons for reoperation included CHF (n = 9), hemolysis (n = 4), systolic anterior leaflet motion (n = 2), and endocarditis (n = 1). At reoperation, 7 patients had partial dehiscence of the annuloplasty band. The incidence of band dehiscence was not associated with the use of U-clips and decreased with experience.

: Reoperative rates seemed to decrease with increased case volume and surgeon's experience. Repair results using robotic techniques are similar to conventional techniques. The use of U-clips is not associated with a higher reoperation rate.