540 consecutive robotic mitral valve repairs including concomitant atrial fibrillation cryoablation

The first complete robotic mitral valve repairs (RMVP) and RMVP with CryoMaze (RMVP+C) were done in the United States in May 2000 and October 2003, respectively. We have previously reported our initial 300 isolated RMVPs. Our current study evaluates our consecutive RMVP series, including patients undergoing concomitant atrial fibrillation (AF) cryoablation.

Between May 2000 and April 2010, patients with symptomatic, nonischemic, moderate to severe mitral insufficiency with or without AF were studied. Robotic CryoMaze included both right and left atrial lesion sets. Data were collected prospectively on all patients. Procedures were performed with the three-dimensional da Vinci telesurgical system. Postoperative rhythm was followed up 6 weeks later; 3, 6, and 12 months later, and yearly thereafter with the Cardionet home monitoring system, Holter monitor, and/or serial electrocardiograms. An unpaired two-tailed t test was used for statistical analysis.

Five hundred forty patients with either 3+ or 4+ mitral insufficiency underwent repair. Of those 540, 454 (84.1%) underwent RMVP and 86 (15.9%) underwent RMVP+C. The patients' mean ages in the RMVP and RMVP+C groups were 56.1 ± 12.9 and 65.6 ± 10.8 years, respectively (mean ± SD) (p < 0.001). Furthermore, mean cardiopulmonary bypass and cross-clamp times for RMVP and RMVP+C were 153.2 ± 37.7 minutes vs. 188.5 ± 53.8 minutes, and 116.6 ± 31.5 minutes vs. 130.6 ± 28.4 minutes, respectively (p < 0.001). Postrepair transesophageal echocardiography showed 447 (82.8%) patients with no mitral insufficiency, 80 (14.8%) with trace, 12 (2.2%) with mild, and 3 (0.6%) with moderate mitral insufficiency. In those who underwent RMVP+C, freedom from AF without taking antiarrhythmic drugs or warfarin was achieved in 96.5% of patients.

Although patients were significantly older and operative times were significantly longer for patients having RMVP+C, the results for both successful repair and conversion to sinus rhythm were comparable to published standards. As comfort level is achieved and robotic technology advances, endoscopic repairs and surgical treatment for AF may become a standard.