Short-term outcomes of robotic left ventricular patch ventriculoplasty for significant mitral annular calcification

Surgical management of mitral annular calcification remains challenging. Our institution pursued a strategy of total mitral annular calcification resection with pericardial patch reconstruction of the left ventricle when primary atrioventricular groove closure was not possible. We present the short-term outcomes derived after implementing this strategy.

A single-institution retrospective analysis included patients with significant mitral annular calcification undergoing totally endoscopic robotic mitral valve surgery between October 2009 and August 2023. Mitral valve repair was performed in patients with sufficient posterior leaflet length. Patients requiring pericardial patch ventriculoplasty were compared with those in whom primary atrioventricular groove closure was possible (non-pericardial patch ventriculoplasty).

Of 1441 patients who underwent totally endoscopic mitral valve surgery, 217 (15.1%) presented with significant mitral annular calcification. Pericardial patch ventriculoplasty was performed in 69 patients (31.8%). Patients undergoing non-pericardial patch ventriculoplasty were significantly younger than patients undergoing pericardial patch ventriculoplasty (63.4 vs 67.8 years, P = .01). Mitral valve repair was conducted in 145 patients (98.0%) in the non-pericardial patch ventriculoplasty group versus 56 patients (81.2%) in the pericardial patch ventriculoplasty group (P < .01). The median postoperative length of stay was significantly shorter in the non-pericardial patch ventriculoplasty group (3 vs 5 days, P < .01). There was no significant difference in postoperative stroke (0.7% vs 2.9%, P = .50) or 30-day mortality (1.4% vs 1.4%, P = 1.00). Three-year survival was comparable between the groups (97.4% vs 93.7%, P = .52).

Totally endoscopic robotic mitral valve repair is a safe and feasible technique for the management of mitral annular calcification with promising results at 3 years. Patients who required atrioventricular groove pericardial patch reconstruction had similar outcomes to those in whom primary closure was possible.