Robotic Mitral Valve Repair Through Nonresectional Posterior Leaflet Remodeling

The nonresectional posterior leaflet remodeling technique through free margin running suture (FMRS) has been recently introduced for the management of complex degenerative lesions of the posterior mitral leaflet. It aims at providing a novel tool in the mitral surgeon's armamentarium to improve the reproducibility and durability of repair, namely in cases characterized by more severe degenerative disease (Barlow and extensive fibroelastic deficiency lesions). Although FMRS can be performed through any surgical access, its features render it particularly adapted to minimally invasive mitral surgery. We describe for the first time the characteristics of FMRS in the context of robotic-assisted mitral repair. A stepwise approach is employed for presentation. The diffusion of robotic-assisted mitral repair has been limited by both economic and reproducibility issues; we hypothesize that FMRS may be helpful in improving the reproducibility of minimally invasive and robotic-assisted mitral surgery. We also discuss the initial clinical results of FMRS.