Totally Endoscopic, Robotic-Assisted Mitral Valve Surgery in Octogenarians and Nonagenarians: Short–Term Outcomes
Presented During:
Thursday, May 4, 2023: 6:30PM - Saturday, May 6, 2023: 2:29AM
New York Hilton Midtown
Posted Room Name:
Grand Ballroom Foyer
Abstract No:
MP075
Submission Type:
Abstract Submission
Authors:
Andrea Amabile (1), James Antonios (2), Adrian Acuna Higaki (1), Ziad Hassan (3), Syed Usman Bin Mahmood (4), Irbaz Hameed (5), Alyssa Morrison (6), Sigurdur Ragnarsson (4), Ritu Agarwal (6), Michael LaLonde (7), Wei-Guo Ma (8), Markus Krane (9), Arnar Geirsson (10)
Institutions:
(1) Yale School of Medicine, New Haven, CT, (2) Yale University, New Haven, CT, (3) Yale, new haven, CT, (4) N/A, N/A, (5) Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT, (6) Yale, New Haven, CT, (7) Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, (8) Beijing Anzhen Hospital, CHESHIRE, Connecticut, (9) Division of Cardiac Surgery, Yale School of Medicine, New Haven, CT, (10) Yale New Haven Hospital, New Haven, CT
Submitting Author:
Andrea Amabile
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Yale School of Medicine
Yale School of Medicine
Co-Author(s):
James Antonios
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Yale University
Yale University
Adrian Acuna Higaki
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Yale School of Medicine
Yale School of Medicine
Ziad Hassan
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Yale
Yale
Syed Usman Bin Mahmood
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N/A
N/A
Irbaz Hameed
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Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine
Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine
Alyssa Morrison
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Yale
Yale
Sigurdur Ragnarsson
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N/A
N/A
Ritu Agarwal
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Yale
Yale
Michael LaLonde
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Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine
Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine
Wei-Guo Ma
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Beijing Anzhen Hospital
Beijing Anzhen Hospital
Markus Krane
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Division of Cardiac Surgery, Yale School of Medicine
Division of Cardiac Surgery, Yale School of Medicine
*Arnar Geirsson
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Yale New Haven Hospital
Yale New Haven Hospital
Presenting Author:
Andrea Amabile
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Yale School of Medicine
Yale School of Medicine
Abstract:
Objective: The adoption of anterolateral minithoracotomy for mitral valve surgery in elderly patients has proven to be safe and effective. Whether the same benefits persist in octo–nonagenarians undergoing robotic-assisted procedures remains unclear. We aimed to evaluate short-term outcomes of octo–nonagenarians undergoing totally endoscopic, robotic-assisted mitral valve surgery at a quaternary academic institution.
Methods: We performed a retrospective, cohort study including patients who underwent totally endoscopic, robotic-assisted mitral valve surgery between 08/2019 and 08/2022. Demographics, comorbidities, intraoperative, and postoperative data were collected from our Society of Thoracic Surgeons (STS) institutional database.
Results: Twenty-one patients met inclusion criteria. Median age was 82 years (range, 80–91). Demographics and comorbidities are detailed in Table 1. Eighteen patients (85.7%) underwent a variety of robotic-assisted mitral valve repair techniques (7 triangular resections, 1 sliding annuloplasty, 5 clefts closure, 4 commissural plications, 4 anterior neochordoplasty, 4 posterior neochordoplasty, 1 commissural neochordoplasty); all patients underwent concomitant mitral annuloplasty, with a median annuloplasty band size of 30 (28–32) mm. All patients had satisfactory repair. Three patients (14.3%) underwent robotic-assisted mitral valve replacement, with a median prosthesis size of 27 (25–33) mm. Left atrial appendage exclusion was performed in all patients, and tricuspid valve repair in 7 patients (33.3%).
Cardiopulmonary bypass and cross-clamp times were 138±42 and 89±31 minutes, respectively. No intraoperative complications occurred, and 9 patients (42.9%) were extubated in the operating room. Overall, the median STS predicted risk of mortality was 2.7% [1.7%–3.9%], the median predicted risk of morbidity and mortality was 11.2% [9.6–17.0%], the median predicted risk of prolonged ventilation was 6.8% [5.5–11.6%], and the median predicted risk of stroke was 2.3% [1.9–3.0%]. Postoperatively, one patient developed pleural effusion, one patient deep venous thrombosis, and one patient required permanent pacemaker implantation. Neither intraoperative, nor in-hospital, or 30-day deaths occurred.
Conclusion: Results of this study suggest that octogenarians and nonagenarians can safely and effectively undergo totally endoscopic, robotic–assisted mitral valve surgery with satisfactory surgical and short-term outcomes.
Methods: We performed a retrospective, cohort study including patients who underwent totally endoscopic, robotic-assisted mitral valve surgery between 08/2019 and 08/2022. Demographics, comorbidities, intraoperative, and postoperative data were collected from our Society of Thoracic Surgeons (STS) institutional database.
Results: Twenty-one patients met inclusion criteria. Median age was 82 years (range, 80–91). Demographics and comorbidities are detailed in Table 1. Eighteen patients (85.7%) underwent a variety of robotic-assisted mitral valve repair techniques (7 triangular resections, 1 sliding annuloplasty, 5 clefts closure, 4 commissural plications, 4 anterior neochordoplasty, 4 posterior neochordoplasty, 1 commissural neochordoplasty); all patients underwent concomitant mitral annuloplasty, with a median annuloplasty band size of 30 (28–32) mm. All patients had satisfactory repair. Three patients (14.3%) underwent robotic-assisted mitral valve replacement, with a median prosthesis size of 27 (25–33) mm. Left atrial appendage exclusion was performed in all patients, and tricuspid valve repair in 7 patients (33.3%).
Cardiopulmonary bypass and cross-clamp times were 138±42 and 89±31 minutes, respectively. No intraoperative complications occurred, and 9 patients (42.9%) were extubated in the operating room. Overall, the median STS predicted risk of mortality was 2.7% [1.7%–3.9%], the median predicted risk of morbidity and mortality was 11.2% [9.6–17.0%], the median predicted risk of prolonged ventilation was 6.8% [5.5–11.6%], and the median predicted risk of stroke was 2.3% [1.9–3.0%]. Postoperatively, one patient developed pleural effusion, one patient deep venous thrombosis, and one patient required permanent pacemaker implantation. Neither intraoperative, nor in-hospital, or 30-day deaths occurred.
Conclusion: Results of this study suggest that octogenarians and nonagenarians can safely and effectively undergo totally endoscopic, robotic–assisted mitral valve surgery with satisfactory surgical and short-term outcomes.
Mitral Conclave:
Minimally Invasive & Robotic Mitral Valve Repair
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