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Mid-term Echocardiographic Follow-up of Mitral Valve Durability Following Robotic Mitral Repair
Jae Suk Yoo, Joon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee.
Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of.

Objective: To review a single surgeon's experience on robotic mitral valve (MV) repair for mitral regurgitation (MR), focusing on the mid-term echocardiographic mitral durability.
Methods: A total of 200 patients who underwent robotic MR repair using da Vinci system between August 2007 and December 2012 were evaluated. Transesophageal echocardiography was used intraoperatively to estimate the results and regular transthoracic echocardiographic follow-up was performed to detect MR recurrence.
Results: MR repair was successfully performed with none or mild residual MR in 98.0% (Figure A), without any conversion to sternotomy. Various repair techniques including ring annuloplasty (99.5%), artificial chordae formation (45.5%), leaflet resection (44.5%), commissuroplasty (35.0%), sliding annuloplasty (3.0%), chordal transfer (2.5%), cleft repair (2.5%), papillary muscle release (1.5%) and leaflet augmentation (1.1%) were utilized. Concomitant maze procedures were performed in 44 patients (22.0%). There were no in-hospital deaths. Clinical follow-up was complete in 96.5 % of patients with a median of 31.4 months (inter-quartile range: 12.4-42.3 months), during which 4 late deaths, 2 strokes, 1 low cardiac output, 1 newly required dialysis, and 1 reoperation for MR occurred. Freedom from major adverse cardiac and cerebrovascular events at 5 years was 87.7 ± 5.1%. Regular echocardiographic follow-up (more than 6 months) was possible in 187 patients (93.5%). At a median of 29.6 months (inter-quartile range: 14.9-45.8 months), 21 (10.5%) experienced moderate or greater MR. Freedom from moderate or greater MR at 5 years was 87.0 ± 2.6% (Figure B). Mean cardiopulmonary bypass and cross-clamping times were 182.9 ± 48.4 and 110.9 ± 34.1 minutes, respectively, both of which were significantly decreased based on chronological date of operation.
Conclusions: Robotic MV repair is technically feasible and efficacious in terms of favorable mid-term mitral durability, utilizing various types of repair techniques with reasonable outcomes, and with improvement in procedure times as experience is accumulated.

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