Totally Endoscopic and Percutaneously approached Robotic Mitral Valve Re-repair after the failure of Transcatheter Mitral Valve Repair

MO005 

Case Video Submission 

Daisuke Kaneyuki (1), Colin Yost (1), Meagan Wu (1), Douglas Pfeil (1), Praveen Mehrotra (1), T. Sloane Guy (2)

(1) Thomas Jefferson University Hospital, Philadelphia, PA, (2) Georgia Heart Institute, Gainesville, GA

Daisuke Kaneyuki    -  Contact Me
Thomas Jefferson University Hospital

Colin Yost    -  Contact Me
Thomas Jefferson University Hospital

Meagan Wu    -  Contact Me
Thomas Jefferson University Hospital

Douglas Pfeil    -  Contact Me
Thomas Jefferson University Hospital

Praveen Mehrotra    -  Contact Me
Thomas Jefferson University Hospital

Thomas Guy    -  Contact Me
Georgia Heart Institute

Daisuke Kaneyuki    -  Contact Me
N/A

Objective: We demonstrate robotic mitral valve (MV) re-repair after the failure of transcatheter MV repair.
Case Video Summary: The patient was an 82-year-old woman with a history of transcatheter MV repair with two clips four years ago for severe mitral regurgitation (MR) due to P2 prolapse with torn chordae. She was indicated for the surgery because of symptomatic severe residual MR, severe tricuspid regurgitation, and paroxysmal atrial fibrillation. Preoperative transesophageal echocardiogram (TEE) showed P2 prolapse with MR jet medial to P2. Four 8-mm robotic ports and one 8-mm working port were on the right-side chest. Peripheral cannulation was performed percutaneously. Cardiac arrest was achieved with intra-aortic balloon clamping followed by delivery of antegrade cardioplegia. The left atriotomy was performed. Iatrogenic patent foramen ovale by previous transcatheter procedure was directly closed. The left atrial cryo maze was performed followed by the left atrial appendage closure. Re-endothelialization between A2 and P2 was dissected with electrocautery and previous repair clips were exposed. A 2-0 Ethibond suture needle was passed through the loop of the locking mechanism. Retraction forces of the suture on the locking mechanism were applied by a bedside assistant with simultaneous use of two robotic instruments to open both arms of the clip. Once the device was unlocked and clip were opened, the clip was gently separated from the leaflets. Two clips were removed out of the body through an 8 mm working port. P2 prolapse with torn chordae was noted on water saline test. Two sets of CV-4 neochordae were placed to medial and lateral sides of the P2 from posteromedial and anterolateral papillary muscle, respectively. MV annuloplasty was performed with 32 mm flexible partial band. MV was competent on water saline test. The left atrium was closed. Subsequently, tricuspid valve annuloplasty was performed with 28 mm flexible partial band. Cross clamp time was 178 minutes. The patient was weaned off cardiopulmonary bypass without difficulties. Post-repair TEE showed no residual MR. She was extubated in the operating room. Although her hospital stay was extended due to bradycardia with junctional rhythm, she recovered sinus rhythm and was discharged on postoperative day 7 without pacemaker implantation.
Conclusions: MV is repairable even after the failure of transcatheter MV repair via totally endoscopic and percutaneous robotic approach.

Minimally Invasive & Robotic Mitral Valve Repair