MO05. Totally Endoscopic and Percutaneously approached Robotic Mitral Valve Re-repair after the failure of Transcatheter Mitral Valve Repair
NewYork- Presbyterian/Columbia University Medical Center
Greensburg, PA
United States - Contact Me
Daisuke Kaneyuki, MD, is a cardiac surgeon at Independence Health System Westmoreland Hospital in Pennsylvania. He completed his cardiovascular surgery residency in Japan, where he received comprehensive training in adult cardiac surgery. He subsequently pursued advanced clinical fellowships in cardiac surgery at Mayo Clinic in Rochester, Minnesota, and Thomas Jefferson University in Philadelphia, Pennsylvania. He further specialized in mechanical circulatory support and heart transplantation through an advanced fellowship at Columbia University Irving Medical Center in New York.
Dr. Kaneyuki’s clinical and research interests focus on off-pump coronary artery bypass (OPCAB), minimally invasive and robotic cardiac surgery, and mechanical circulatory support (MCS), including durable left ventricular assist devices (LVADs) and heart transplantation. He is particularly interested in optimizing outcomes in advanced heart failure patients and integrating less invasive techniques into complex cardiac procedures.
Description
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.