Robotic mitral valve repair: pericardiotomy and aortic cross-clamp application

Robotic mitral valve surgery requires pericardiotomy via the right chest. Opening more anterior than traditionally described enhances visualization of the right ventricle, obviates the need for anterior pericardial stays, and keeps the lung out of the way posteriorly. We prefer to utilize an external cross-clamp for aortic occlusion due to its simplicity and reproducibility and now use a detachable clamp, which avoids potential conflicts with robotic instruments. Herein we describe our current technique for these important components of robotic valve surgery.