Cardiovascular Surgery Department, Mayo Clinic, Rochester, Minnesota.
Cardiovascular Surgery Department, Mayo Clinic, Rochester, Minnesota.
Ann Thorac Surg. 2022 Nov;114(5):1587-1595. doi: 10.1016/j.athoracsur.2021.08.083. Epub 2021 Nov 18.
Surgical approaches for mitral valve (MV) disease have evolved with the aim of developing minimally invasive techniques. Although the safety of robotic procedures has been documented, there are limited data on long-term echocardiographic follow-up. This review demonstrates outcomes of 11 years of robotic MV repair at a single, tertiary institution.
From 2008 to 2019, 843 patients underwent robotic MV repair at Mayo Clinic in Rochester, Minnesota. Repeated measures generalized least squares (GLS) modeling was used to assess the echocardiographic changes over time.
The median age was 58 years (interquartile range, 50.8, 65.5 years), and 591 were male (70.1%). The mechanism of mitral regurgitation was posterior leaflet prolapse in 479 (56.8%) patients, bileaflet prolapse in 325 (38.6%), and anterior leaflet prolapse in 36 (4.3%). There were 3 early deaths (0.4%) and 24 early reoperations (2.8%). Echocardiographic follow-up demonstrated left ventricular end-systolic and end-diastolic dimensions, left atrial volume index, and pulmonary pressure all continuously improved up to 2 years postoperatively. Ejection fraction immediately declined postoperatively but then gradually improved to near normal over 2 years. Survival and freedom from reoperation at 10 years were 93% and 92.6%, respectively. When patients were surveyed after dismissal, 93.4% reported their activity level at or above their peers, and 93.3% reported no activity limitation from cardiac symptoms.
Robotic MV repair is safe and effective with excellent long-term results, including echocardiographic data that demonstrated early improvement in cardiac chamber size and maintenance of postoperative cardiac function. Exceedingly low mortality rates and freedom from reoperation are comparable to those of the standard open repair.
二尖瓣（MV）疾病的手术方法已经发展，目的是开发微创技术。虽然机器人手术的安全性已得到证实，但关于长期超声心动图随访的数据有限。本综述展示了在一家三级机构进行机器人 MV 修复 11 年的结果。
2008 年至 2019 年，明尼苏达州罗切斯特市梅奥诊所共有 843 例患者接受了机器人 MV 修复。重复测量广义最小二乘（GLS）模型用于评估随时间的超声心动图变化。
中位年龄为 58 岁（四分位距，50.8，65.5 岁），591 例为男性（70.1%）。二尖瓣反流的机制为后叶脱垂 479 例（56.8%），双叶脱垂 325 例（38.6%），前叶脱垂 36 例（4.3%）。有 3 例早期死亡（0.4%）和 24 例早期再次手术（2.8%）。超声心动图随访显示左心室收缩末期和舒张末期尺寸、左心房容积指数和肺动脉压均在术后 2 年内持续改善。射血分数术后立即下降，但随后在 2 年内逐渐恢复正常。10 年生存率和免于再次手术率分别为 93%和 92.6%。当患者在出院后接受调查时，93.4%报告他们的活动水平与同龄人相当，93.3%报告没有因心脏症状而限制活动。
机器人 MV 修复安全有效，长期效果极佳，包括超声心动图数据显示心脏腔室大小早期改善和术后心功能维持。极低的死亡率和免于再次手术率与标准开放式修复相当。
