Department of Cardiac Surgery, National Cerebral and Cardiovascular Research Center, 6-1 Kishibe-Shinmachi, Suita, Osaka, 564-8565, Japan.
Department of Surgical Intensive Care, National Cerebral and Cardiovascular Research Center, Suita, Osaka, Japan.
Gen Thorac Cardiovasc Surg. 2020 Oct;68(10):1079-1085. doi: 10.1007/s11748-020-01317-2. Epub 2020 Feb 18.
Robotically assisted mitral valve repair was approved for use in Japan in April 2018. The study objective was to assess the safety and clinical outcomes of robotic mitral valve surgery in the first 100 cases performed in our center.
We reviewed the first 100 patients who underwent robotic primary mitral valve repair, including concomitant procedures, from April 2018 to August 2019. The cause of mitral valve disease was degenerative (n = 94), endocarditis (n = 2), functional (n = 2), and other (n = 2).
There was no in-hospital or 30-day mortality. Mitral valve repair was completed in all patients. Only one patient required conversion to full sternotomy due to left ventricular apex bleeding. In echocardiography performed before hospital discharge, the mitral regurgitation was graded as none or trivial in 94 patients (94%) and mild in 4 (4%). Only two patients required surgical re-intervention due to postoperative hemolysis with moderate mitral regurgitation. For patients who underwent the mitral valve procedure alone, the median times of the total operation, cardiopulmonary bypass, aortic clamping, and console usage were 185, 112, 71, and 60 min, respectively. The learning curve showed that the operation time decreased slightly during the first ten cases and then plateaued at a mean of approximately 180 min.
Robotically assisted mitral valve repair was feasible, safe, and therapeutically effective in the first 100 cases, with a minimal learning curve. The robotically assisted approach provides a high-quality surgical view and tremorless suture/cut handling, which will contribute to further development of minimally invasive mitral valve surgery.
机器人辅助二尖瓣修复术于 2018 年 4 月在日本获得批准使用。本研究旨在评估我们中心前 100 例机器人二尖瓣手术的安全性和临床结果。
我们回顾了 2018 年 4 月至 2019 年 8 月期间因原发性二尖瓣疾病接受机器人二尖瓣修复术的前 100 例患者（包括同时进行的手术）。二尖瓣疾病的病因包括退行性病变（n=94）、感染性心内膜炎（n=2）、功能性（n=2）和其他（n=2）。
无院内或 30 天死亡。所有患者均完成二尖瓣修复。仅有 1 例患者因左心室心尖出血转为全胸骨切开术。在出院前进行的超声心动图检查中，94 例（94%）患者的二尖瓣反流程度为无或轻度，4 例（4%）患者为轻度。仅 2 例患者因术后中度二尖瓣反流和溶血性贫血需要再次手术干预。对于仅行二尖瓣手术的患者，总手术、体外循环、主动脉阻断和控制台使用时间的中位数分别为 185、112、71 和 60 分钟。学习曲线显示，在前 10 例手术中，手术时间略有下降，然后稳定在平均约 180 分钟。
机器人辅助二尖瓣修复在前 100 例中是可行的、安全的、有效的，学习曲线较短。机器人辅助方法提供了高质量的手术视野和无震颤的缝合/切割处理，这将有助于微创二尖瓣手术的进一步发展。
