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A. Marc Gillinov - One of the best experts on this subject based on the ideXlab platform.
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Robotic Mitral Valve Repair
Indian Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Hoda Javadikasgari, Rakesh M. Suri, Stephanie Mick, Tomislav Mihaljevic, A. Marc GillinovAbstract:Historically, Mitral Valve Repair has been preferred over replacement in the treatment of degenerative Mitral Valve disease, and the conventional sternotomy approach has demonstrated excellent safety and long-term durability. However, surgeons continue to seek less invasive surgical approaches that maintain the high standards set for Mitral Valve Repair. Robotic Mitral Valve surgery was introduced in 1998 to reproduce excellent conventional sternotomy results with less invasive techniques. This technology is now routinely performed for delivering complete anatomic correction of all categories of Mitral Valve prolapse, regardless of disease complexity, with or without concomitant tricuspid Valve Repair and atrial fibrillation ablation procedures. Herein, we review current status of robotic Mitral Valve surgery techniques.
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Percutaneous Mitral Valve Repair
Seminars in thoracic and cardiovascular surgery, 2006Co-Authors: A. Marc Gillinov, John R. LiddicoatAbstract:Surgical Mitral Valve Repair is the procedure of choice to treat Mitral regurgitation of all etiologies. Whereas annuloplasty is the cornerstone of Mitral Valve Repair, a variety of other surgical techniques are utilized to correct dysfunction of the leaflets and subvalvular apparatus; in most cases, surgical Repair entails application of multiple Repair techniques in each patient. Preclinical studies and early human experience have demonstrated that some of these surgical Repair techniques can be performed using percutaneous approaches. Specifically, there has been great progress in the development of novel technology to facilitate percutaneous annuloplasty and percutaneous edge-to-edge Repair. The objectives of this report were to (1) discuss the surgical foundations for these percutaneous approaches; (2) review device design and experimental and clinical results of percutaneous Valve Repair; and (3) address future directions, including the key challenges of patient selection and clinical trial design.
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Mitral Valve Repair with aortic Valve replacement is superior to double Valve replacement
The Journal of thoracic and cardiovascular surgery, 2003Co-Authors: A. Marc Gillinov, Delos M Cosgrove, Eugene H. Blackstone, Jennifer A. White, Paul Kerr, Antonino G.m. Marullo, Patrick M. Mccarthy, Bruce W. LytleAbstract:Abstract Objectives Double Valve replacement has been advocated for patients with combined aortic and Mitral Valve disease. This study investigated the alternative that, when feasible, Mitral Valve Repair with aortic Valve replacement is superior. Patients and methods From 1975 to 1998, 813 patients underwent aortic Valve replacement with either Mitral Valve replacement (n = 518) or Mitral Valve Repair (n = 295). Mitral Valve disease was rheumatic in 71% and degenerative in 20%. Mitral Valve replacement was more common in patients with severe Mitral stenosis ( P = .0009), atrial fibrillation ( P = .0006), and in patients receiving a mechanical aortic prosthesis ( P = .0002). These differences were used for propensity-matched multivariable comparisons. Follow-up extended reliably to 16 years, mean 6.9 ± 5.9 years. Results Hospital mortality rate was 5.4% for Mitral Valve Repair and 7.0% for replacement ( P = .4). Survivals at 5, 10, and 15 years were 79%, 63%, and 46%, respectively, after Mitral Valve Repair versus 72%, 52%, and 34%, respectively, after replacement ( P = .01). Late survival was increased by Mitral Valve Repair rather than replacement ( P = .03) in all subsets of patients, including those with severe Mitral Valve stenosis. After Repair of nonrheumatic Mitral Valves, 5-, 10-, and 15-year freedom from Valve replacement was 91%, 88%, and 86%, respectively; in contrast, after Repair of rheumatic Valves, it was 97%, 89%, and 75% at these intervals. Conclusions In patients with double Valve disease, aortic Valve replacement and Mitral Valve Repair (1) are feasible in many, (2) improve late survival rates, and (3) are the preferred strategy when Mitral Valve Repair is possible.
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Current status of Mitral Valve Repair.
The American heart hospital journal, 2003Co-Authors: A. Marc Gillinov, Delos M CosgroveAbstract:Mitral Valve Repair is the procedure of choice to treat Mitral Valve dysfunction. Advantages of Mitral Valve Repair over Mitral Valve replacement include improved long-term survival, better preservation of left ventricular function, and greater freedom from endocarditis, thromboembolism, and anticoagulant-related hemorrhage. The feasibility and durability of Mitral Valve Repair depend upon the etiology of Mitral Valve dysfunction. In degenerative and ischemic Mitral Valve diseases, Valve Repair is possible in 90% of cases and freedom from reoperation is high. In contrast, rheumatic Valves are less amenable to Repair and durability is limited. Most isolated Valve operations can be performed in a minimally invasive fashion using a partial upper sternotomy. In patients with atrial fibrillation and Mitral Valve disease, the Maze procedure or pulmonary vein isolation is performed, eliminating atrial fibrillation and the need for long-term anticoagulation.
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Reoperation for failure of Mitral Valve Repair
The Journal of thoracic and cardiovascular surgery, 1997Co-Authors: A. Marc Gillinov, Delos M Cosgrove, Patrick M. Mccarthy, Bruce W. Lytle, Paul C. Taylor, Robert W. Stewart, Nicholas G. Smedira, Derek D. Muehrcke, Carolyn Apperson-hansen, Floyd D. LoopAbstract:Abstract Background and Objective: Mitral Valve Repair is the procedure of choice to correct Mitral regurgitation of all types. Up to 10% of patients who undergo Mitral valvuloplasty require late reoperation for recurrent Mitral Valve dysfunction. To determine the causes of failed Mitral Valve Repair, we examined the surgical pathology of patients who underwent reoperation for failed Mitral Valve Repair. Patients and Results: From 1986 to 1994, 81 patients had 86 reoperations for recurrent Mitral regurgitation after Mitral Valve Repair. Mean age was 59.2 ± 1.4 years; 55 were men. Primary Valve disease was degenerative in 48 patients (59%), rheumatic in 16 (20%), ischemic in 13 (16%), endocarditic in 3 (4%), and congenital in 1 (1%). Mean time interval between initial Mitral Valve Repair and reoperation was 15.6 ± 2.5 months. Causes of Repair failure were procedure-related (50 cases, 58%), Valve-related (33 cases, 38%), or unknown (3 cases, 3%). Procedure-related Valve failure was caused by suture dehiscence (21 cases), rupture of previously shortened chordae (19 cases), or incomplete initial correction (10 cases). Valve-related Repair failure was caused by progressive primary Valve disease (27 cases), endocarditis (5 cases), or extensive leaflet retraction (1 case). Repair failure was procedure-related in 70% of patients with degenerative valvular disease versus only 13% of patients with rheumatic valvular disease ( p = 0.0001). At reoperation, Mitral Valve replacement was performed in 64 patients (79%) and repeat Mitral Valve Repair in 17 (21%). Conclusion: We conclude that (1) most Mitral Valve Repair failures are procedure-related in degenerative disease and Valve-related in rheumatic disease; (2) rupture of previously shortened chordae is a common cause of late failure in patients with degenerative Mitral Valve disease; and (3) repeat Mitral Valve Repair results in successful treatment for a minority of patients. (J Thorac Cardiovasc Surg 1997;113:467-75)
Rakesh M. Suri - One of the best experts on this subject based on the ideXlab platform.
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Techniques for Mitral Valve Repair
Cardiac Surgery, 2020Co-Authors: Bassman Tappuni, Hoda Javadikasgari, Bajwa Gurjyot, Rakesh M. SuriAbstract:Myxomatous degeneration of Mitral Valve apparatus affects 2–3% of the general population and it is the most common cause of severe Mitral regurgitation in western countries. More than 90% of degenerative Mitral Valves are suitable for Valve Repair rather than replacement, with short and long term clinical outcomes being superior after Repair. In addition to the clinical benefits, Mitral Valve Repair is associated with an economic benefit in the form of reduced short and long term medical expenses. Patients who have undergone Mitral Valve Repair have Mitral function restored, have avoided the added expense of a prosthetic Valve and are free from lifelong anti-coagulation requirement. A variety of surgical approaches (sternotomy, anterolateral thoracotomy, and robotic assisted procedures) and Repair techniques have been developed over the last four decades to treat Mitral Valve regurgitation. In this chapter, we delineate different aspects of Mitral Valve Repair techniques.
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Robotic Mitral Valve Repair
Indian Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Hoda Javadikasgari, Rakesh M. Suri, Stephanie Mick, Tomislav Mihaljevic, A. Marc GillinovAbstract:Historically, Mitral Valve Repair has been preferred over replacement in the treatment of degenerative Mitral Valve disease, and the conventional sternotomy approach has demonstrated excellent safety and long-term durability. However, surgeons continue to seek less invasive surgical approaches that maintain the high standards set for Mitral Valve Repair. Robotic Mitral Valve surgery was introduced in 1998 to reproduce excellent conventional sternotomy results with less invasive techniques. This technology is now routinely performed for delivering complete anatomic correction of all categories of Mitral Valve prolapse, regardless of disease complexity, with or without concomitant tricuspid Valve Repair and atrial fibrillation ablation procedures. Herein, we review current status of robotic Mitral Valve surgery techniques.
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Mitral Valve Repair using robotic technology safe effective and durable
The Journal of Thoracic and Cardiovascular Surgery, 2016Co-Authors: Rakesh M. Suri, Hoda Javadikasgari, Tomislav Mihaljevic, Joseph A. Dearani, Randolph W Chitwood, Douglas A Murphy, Alfredo Trento, Harold M Burkhart, Wiley Nifong, Richard C. DalyAbstract:The most recent American College of Cardiology/American Heart Association heart Valve guidelines recommend that prompt surgical correction of severe degenerative Mitral Valve regurgitation, ideally Mitral Valve Repair, should be performed to decrease the risks of long-term mortality and heart failure risks associated with this condition. Mitral Valve Repair performed using a minimally invasive robotic approach can now be successfully carried out in nearly all cases of degenerative disease with very low risks of stroke or death. Experienced groups have further shown specific advantages of robotic Mitral Valve Repair compared with conventional approaches, including reduced blood loss, lower risks of infection and atrial fibrillation, shorter hospital length of stay, quicker return to normal activities, and a superior cosmetic result. Herein, we discuss the current status of robotic Mitral Valve Repair including indications, technical advances, safety, effectiveness, and durability.
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Robotic-assisted Mitral Valve Repair: surgical technique.
Multimedia manual of cardiothoracic surgery : MMCTS, 2014Co-Authors: Khaled D. Algarni, Rakesh M. Suri, Richard C. DalyAbstract:Robotic-assisted Mitral Valve Repair represents the least invasive surgical approach currently available for anatomical Mitral Valve Repair in patients with myxomatous Mitral Valve disease. Standard Mitral Valve Repair techniques utilized during conventional sternotomy/right thoracotomy are exactly replicated with the robotic instrumentation through 1-2 cm port-like incisions with superior 3D visualization. This is performed on cardiopulmonary bypass by peripheral cannulation of the femoral vessels/right internal jugular vein. The ascending aorta is occluded with a transthoracic aortic cross-clamp. Antegrade cardioplegia is delivered centrally into the aortic root through a cardioplegia vent catheter. By replicating conventional Mitral Valve Repair done via an open sternotomy approach, the quality of Mitral Valve Repair is ensured while providing the patients with advantages of less invasive surgery including shorter hospital stay, rapid recovery and return to normal activities, less blood transfusion, superior cosmesis and complete elimination of sternotomy-related morbidities such as deep sternal wound infection and sternal dehiscence. We reviewed the first consecutive 200 patients undergoing robotic Mitral Valve Repair at Mayo Clinic Rochester between 24 January 2008 and 28 January 2011. Successful Mitral Valve Repair was completed in all patients. There were no early (30-day) deaths. One patient suffered a stroke (0.5%). One patient required reoperation for bleeding (0.5%). Two patients (1%) required reoperation for recurrent Mitral regurgitation. Twelve patients (6%) required transfusion of allogeneic blood products. We have noted a significant reduction in operative times and resource utilization over time.
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Mitral Valve Repair is durable in patients with rheumatoid arthritis
The Annals of thoracic surgery, 2012Co-Authors: John M. Stulak, Rakesh M. Suri, Eric L. Matteson, Joseph A. Dearani, Heidi M. Connolly, Hartzell V. SchaffAbstract:Background Rheumatoid arthritis (RA) and its treatments are associated with tissue abnormalities, which may influence surgical outcomes of Repair for severe Mitral Valve regurgitation (MR). We examined late survival and durability of Mitral Valve Repair in patients with RA. Methods Thirty-six patients with RA (21 male) underwent Mitral Valve Repair for MR from August 1978 to August 2005. Median age was 70 years (range, 22 to 84). Preoperatively, 27 patients (75%) had New York Heart Association Functional Class III/IV symptoms, and 29 (78%) required immunomodulating medications for RA management. Mechanisms of MR were leaflet prolapse in 26 patients (72%), leaflet malcoaptation in 5 (14%), tethering in 4 (11%), and unknown in 1 (3%). Results All patients underwent Mitral Valve Repair, which included posterior leaflet triangular resection in 11 patients, leaflet plication in 10, and artificial chordae placement in 3. When compared with matched control patients without RA who underwent Mitral Valve Repair, RA patients had decreased survival (27% versus 64%, p = 0.005) and freedom from reoperation (93% versus 98%, p = 0.04) at 8 years. However, RA patients undergoing Mitral Valve Repair had similar survival at 5 years compared with age- and sex-matched comparator patients with RA who did not undergo Mitral Valve surgery (65% versus 67%, p = nonsignificant). Conclusions Mitral leaflet pathology in RA patients with severe MR is similar to that of non-RA patients with Mitral Valve disease. Long-term survival after Mitral Valve Repair in RA patients is equivalent to that of the general RA population without Mitral Valve disease, and the durability of Mitral Valve Repair in these patients is very good.
Hoda Javadikasgari - One of the best experts on this subject based on the ideXlab platform.
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Techniques for Mitral Valve Repair
Cardiac Surgery, 2020Co-Authors: Bassman Tappuni, Hoda Javadikasgari, Bajwa Gurjyot, Rakesh M. SuriAbstract:Myxomatous degeneration of Mitral Valve apparatus affects 2–3% of the general population and it is the most common cause of severe Mitral regurgitation in western countries. More than 90% of degenerative Mitral Valves are suitable for Valve Repair rather than replacement, with short and long term clinical outcomes being superior after Repair. In addition to the clinical benefits, Mitral Valve Repair is associated with an economic benefit in the form of reduced short and long term medical expenses. Patients who have undergone Mitral Valve Repair have Mitral function restored, have avoided the added expense of a prosthetic Valve and are free from lifelong anti-coagulation requirement. A variety of surgical approaches (sternotomy, anterolateral thoracotomy, and robotic assisted procedures) and Repair techniques have been developed over the last four decades to treat Mitral Valve regurgitation. In this chapter, we delineate different aspects of Mitral Valve Repair techniques.
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Robotic Mitral Valve Repair
Indian Journal of Thoracic and Cardiovascular Surgery, 2018Co-Authors: Hoda Javadikasgari, Rakesh M. Suri, Stephanie Mick, Tomislav Mihaljevic, A. Marc GillinovAbstract:Historically, Mitral Valve Repair has been preferred over replacement in the treatment of degenerative Mitral Valve disease, and the conventional sternotomy approach has demonstrated excellent safety and long-term durability. However, surgeons continue to seek less invasive surgical approaches that maintain the high standards set for Mitral Valve Repair. Robotic Mitral Valve surgery was introduced in 1998 to reproduce excellent conventional sternotomy results with less invasive techniques. This technology is now routinely performed for delivering complete anatomic correction of all categories of Mitral Valve prolapse, regardless of disease complexity, with or without concomitant tricuspid Valve Repair and atrial fibrillation ablation procedures. Herein, we review current status of robotic Mitral Valve surgery techniques.
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Mitral Valve Repair using robotic technology safe effective and durable
The Journal of Thoracic and Cardiovascular Surgery, 2016Co-Authors: Rakesh M. Suri, Hoda Javadikasgari, Tomislav Mihaljevic, Joseph A. Dearani, Randolph W Chitwood, Douglas A Murphy, Alfredo Trento, Harold M Burkhart, Wiley Nifong, Richard C. DalyAbstract:The most recent American College of Cardiology/American Heart Association heart Valve guidelines recommend that prompt surgical correction of severe degenerative Mitral Valve regurgitation, ideally Mitral Valve Repair, should be performed to decrease the risks of long-term mortality and heart failure risks associated with this condition. Mitral Valve Repair performed using a minimally invasive robotic approach can now be successfully carried out in nearly all cases of degenerative disease with very low risks of stroke or death. Experienced groups have further shown specific advantages of robotic Mitral Valve Repair compared with conventional approaches, including reduced blood loss, lower risks of infection and atrial fibrillation, shorter hospital length of stay, quicker return to normal activities, and a superior cosmetic result. Herein, we discuss the current status of robotic Mitral Valve Repair including indications, technical advances, safety, effectiveness, and durability.
Richard C. Daly - One of the best experts on this subject based on the ideXlab platform.
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Mitral Valve Repair using robotic technology safe effective and durable
The Journal of Thoracic and Cardiovascular Surgery, 2016Co-Authors: Rakesh M. Suri, Hoda Javadikasgari, Tomislav Mihaljevic, Joseph A. Dearani, Randolph W Chitwood, Douglas A Murphy, Alfredo Trento, Harold M Burkhart, Wiley Nifong, Richard C. DalyAbstract:The most recent American College of Cardiology/American Heart Association heart Valve guidelines recommend that prompt surgical correction of severe degenerative Mitral Valve regurgitation, ideally Mitral Valve Repair, should be performed to decrease the risks of long-term mortality and heart failure risks associated with this condition. Mitral Valve Repair performed using a minimally invasive robotic approach can now be successfully carried out in nearly all cases of degenerative disease with very low risks of stroke or death. Experienced groups have further shown specific advantages of robotic Mitral Valve Repair compared with conventional approaches, including reduced blood loss, lower risks of infection and atrial fibrillation, shorter hospital length of stay, quicker return to normal activities, and a superior cosmetic result. Herein, we discuss the current status of robotic Mitral Valve Repair including indications, technical advances, safety, effectiveness, and durability.
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Robotic-assisted Mitral Valve Repair: surgical technique.
Multimedia manual of cardiothoracic surgery : MMCTS, 2014Co-Authors: Khaled D. Algarni, Rakesh M. Suri, Richard C. DalyAbstract:Robotic-assisted Mitral Valve Repair represents the least invasive surgical approach currently available for anatomical Mitral Valve Repair in patients with myxomatous Mitral Valve disease. Standard Mitral Valve Repair techniques utilized during conventional sternotomy/right thoracotomy are exactly replicated with the robotic instrumentation through 1-2 cm port-like incisions with superior 3D visualization. This is performed on cardiopulmonary bypass by peripheral cannulation of the femoral vessels/right internal jugular vein. The ascending aorta is occluded with a transthoracic aortic cross-clamp. Antegrade cardioplegia is delivered centrally into the aortic root through a cardioplegia vent catheter. By replicating conventional Mitral Valve Repair done via an open sternotomy approach, the quality of Mitral Valve Repair is ensured while providing the patients with advantages of less invasive surgery including shorter hospital stay, rapid recovery and return to normal activities, less blood transfusion, superior cosmesis and complete elimination of sternotomy-related morbidities such as deep sternal wound infection and sternal dehiscence. We reviewed the first consecutive 200 patients undergoing robotic Mitral Valve Repair at Mayo Clinic Rochester between 24 January 2008 and 28 January 2011. Successful Mitral Valve Repair was completed in all patients. There were no early (30-day) deaths. One patient suffered a stroke (0.5%). One patient required reoperation for bleeding (0.5%). Two patients (1%) required reoperation for recurrent Mitral regurgitation. Twelve patients (6%) required transfusion of allogeneic blood products. We have noted a significant reduction in operative times and resource utilization over time.
Art Sedrakyan - One of the best experts on this subject based on the ideXlab platform.
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A Population-Based Analysis of Robotic-Assisted Mitral Valve Repair
The Annals of thoracic surgery, 2015Co-Authors: Subroto Paul, Abby J. Isaacs, Jessica J. Jalbert, Nonso C. Osakwe, Arash Salemi, Leonard N. Girardi, Art SedrakyanAbstract:Background Robotic-assisted Mitral Valve Repair is becoming more frequently performed in cardiac surgery. However, little is known about its utilization and safety at a national level. Methods Patients undergoing Mitral Valve Repair in the United States from 2008 to 2012 were identified in the National Inpatient Sample. Inhospital mortality, complications, length of stay, and cost for patients undergoing robotic-assisted Mitral Valve Repair were compared with patients undergoing nonrobotic procedures. Results We identified 50,408 isolated Mitral Valve Repair surgeries, of which 3,145 were done with robotic assistance. In a propensity score matched analysis of 631 pairs of patients, we found no difference between patients undergoing robotic-assisted and nonrobotic-assisted Mitral Valve Repair with respect to inhospital mortality, complications, or composite outcomes in unadjusted or multivariable analyses. Robotic-assisted Mitral Valve Repair surgery was associated with a shorter median length of stay (4 versus 6 days, p Conclusions In our analysis of a large national database with its inherent limitations, robotic-assisted Mitral Valve Repair was found to be safe, with an acceptable morbidity and mortality profile.