Miniinvasive robotic mitral valve repair using the da Vinci system in the first two patients in Poland – echocardiographic follow-up results 30 months after surgery

Minimally invasive robotic mitral valve repair (rMVR) using the da Vinci system is an alternative to other minimally invasive mitral valve (MV) surgical techniques with important advantages such as small skin incisions, reduced risk of wound infection and arrhythmia, less blood loss and shorter hospitalization [1, 2]. The implementation of new robotic technologies, intensified training of surgeons and a greater demand from patients with MV disease may influence the wider use of this technique in clinical practice.
The first procedures of rMVR using the da Vinci system were performed in two Polish patients in autumn 2018 due to symptomatic severe mitral regurgitation (MR) caused by posterior mitral leaflet prolapse (NYHA II/III).
According to a paper published in 2019, rMVR procedures were guided with the transoesophageal echocardiographic support with a 3D option and their good final result was confirmed [3].
Currently, we would like to present the results of transthoracic echocardiography (TTE) performed in 2 patients 30 months after rMVR. Preoperatively, the first patient (No. 1: 46-year-old man) had a deep P2 prolapse with a significant cleft of the scallop causing a large MR jet (Figure 1 A). During the rMVR the P2 cleft was closed, two neochords were placed in the papillary muscles and a Simulus 31 flexible partial band was implanted. In the second patient (No. 2: 56-year-old man) with at least three broken native chords to the P2 scallop and a strongly eccentric jet of MR (Figure 1 B) a triangular resection of the prolapsing segment was performed (Figure 1 C) and a Simulus 35 partial band was also implanted.
Both patients were followed up carefully (6, 12, 24 and 30 months). Thirty months after rMVR, the first patient had no MR jet (Figure 1 D) and no significant transmitral gradient, and the second patient had only trivial MR (Figure 1 F) and the mean transmitral gradient 3 mm Hg. In addition to the significant reduction of MR degree, decreased left-sided heart dimensions, tricuspid regurgitation peak gradient and right ventricular systolic pressure were also observed. Important cardiac parameters measured immediately before and 30 months after robotic mitral valve repair with the da Vinci system are included in Table I.
The clinical condition and exercise tolerance of both operated patients were good throughout the entire follow-up. Heart murmurs and arrhythmias were not found.
Although robotic...


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