Robotic mitral valve repair for simple and complex degenerative disease

Rakesh M. Suri, Amit Taggarse, Harold M. Burkhart, Richard C. Daly, William Mauermann, Rick A. Nishimura, Zhuo Li, Joseph A. Dearani, Hector I Michelena, Maurice E Sarano

Research output: Contribution to journalArticle

53 Scopus citations

Abstract

Background - Severe primary (degenerative) mitral regurgitation (MR) is repaired with durable results when simple single-scallop disease is addressed. The midterm quality outcomes of minimally invasive repair for complex disease are unknown, however. Methods and Results - From January 2008 to January 2015, 487 patients (56±11 years, 360 men, ejection fraction 65±6%, 98.8% complete follow-up) underwent robotic mitral valve repair for severe nonischemic degenerative MR. Simple pathology was addressed in 289 of 487 (59%) patients, and complex repair (all others) was performed in 198 of 487 (41%). Four patients died during follow-up with a 5-year survival rate 99.5% (99.4% simple; 99.5% complex; hazard ratio, 0.48; 95% confidence interval, 0.05-4.59); and New York Heart Association functional class I/II was documented in 97.9% (477/487). Eight patients had recurrence of moderate-to-severe MR (4 simple, 4 complex), with a 5-year freedom from MR of 94.6% (96.2% simple; 92.7%, complex; P=0.67; hazard ratio, 1.36; 95% confidence interval, 0.34-5.43). Seven patients (2 simple, 5 complex), underwent mitral reoperation, with a 5-year freedom from reoperation of 97.7% (99.1% simple; 95.7% complex; P=0.13; hazard ratio, 3.35; 95% confidence interval, 0.65-17.32). Conclusions - At a large tertiary care referral center, midterm quality outcomes after robotic correction of degenerative MR are excellent, with very high survival, infrequent complications, and a low likelihood of MR recurrence, regardless of mitral valve repair complexity. Awareness of these improvements in outcome is important to inform contemporary decisions regarding high-quality alternatives to conventional and percutaneous mitral repair.

Original languageEnglish (US)
Pages (from-to)1961-1968
Number of pages8
JournalCirculation
Volume132
Issue number21
DOIs
StatePublished - Nov 24 2015

Keywords

  • mitral valve
  • mitral valve annuloplasty
  • prolapse
  • quality improvement

ASJC Scopus subject areas

  • Physiology (medical)
  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Suri, R. M., Taggarse, A., Burkhart, H. M., Daly, R. C., Mauermann, W., Nishimura, R. A., Li, Z., Dearani, J. A., Michelena, H. I., & Sarano, M. E. (2015). Robotic mitral valve repair for simple and complex degenerative disease. Circulation, 132(21), 1961-1968. https://doi.org/10.1161/CIRCULATIONAHA.115.017792