Robotic Mitral Valve Repair Safe, Durable
Alternative to Open Surgical Approaches

The Challenge

Mitral valve regurgitation due to mitral prolapse is common. Many patients will eventually require surgery to repair the faulty valve.

Operating room set-up for robotic heart surgery

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Mitral regurgitation is a clinically challenging condition because it can be asymptomatic early on. Most patients at the time of diagnosis are young and otherwise healthy. They tend to have little understanding of the potential for valve leakage leading to irreversible heart failure. Severe regurgitation may lead to severe irreversible heart damage if not treated.

Data show that medical management of severe mitral regurgitation results in excess mortality. The traditional surgical treatment has been valve repair through a median sternotomy, which was pioneered at Mayo Clinic more than 50 years ago.

Small incisions speed recovery

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While very effective, median sternotomy may discourage some patients from seeking timely treatment because it is an open-chest procedure and patients fear a long, painful recovery. An equally effective, minimally invasive alternative that patients find more tolerable has become available to overcome the limitations of traditional treatment, allowing patients to return to normal activity more quickly.

Mitral valve prolapse being repaired

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Robotic Repair

Robotic mitral valve repair is now performed regularly at Mayo Clinic and a few other high-volume advanced cardiovascular surgery centers. A minimally invasive robotic repair of the mitral valve relies on three-dimensional, high-definition video guidance to visualize the intricate heart anatomy and robotic instrumentation to perform precise valve surgery through several very small incisions.

As one of a few centers performing robotic mitral valve repairs, Mayo Clinic in Minnesota evaluates more than 500 patients a year for mitral valve procedures. Traditional prosthetic valve replacement surgery is an option for some patients, but more than 99 percent of Mayo Clinic patients with pure mitral valve regurgitation due to degenerative disease undergo valve repair to correct leakage.

Mayo Clinic investigators have determined that mitral valve repair offers improved survival compared with mitral valve replacement, allowing patients without atrial fibrillation to remain free of long-term warfarin use.

Mayo Clinic studies have shown that mitral valve repair is as durable as mechanical valve replacement. Valve repair is also associated with a low likelihood of needing a repeat operation. Robotic mitral valve repair provides patients the same excellent results of open mitral valve repair and is performed through small closed-chest incisions.

Advantages

For the patient, robotic mitral valve repair offers several advantages over sternotomy.

• It eliminates the pain and morbidity associated with median sternotomy because the incisions are small — between 1 and 3 cm in length — and generally do not involve cutting bones or ribs.
• Hospitalization time is reduced from seven to 10 days after sternotomy to three or four days.
• Patients may return to work within about two to four weeks after robotic repair compared with eight weeks of recovery generally needed with an open-chest approach.

Mitral valve repair using robotic techniques is desirable for the surgeon because it offers improved precision using instruments designed to mimic the real-time movements of the surgeon's hands and wrists. Instruments are used in conjunction with a high-definition camera, which provides excellent visualization for these complex procedures.

Disadvantages

The main disadvantage of robotic repair is the investment required for surgeons to master the high-precision equipment. At Mayo Clinic, multiple robotic systems are used to perform many robotic-assisted procedures each day.

Indications

At Mayo Clinic, all referred mitral valve patients are considered potential candidates for minimally invasive robotic repair. After a comprehensive evaluation by the medical team, the surgeon decides who is an appropriate candidate on an individual basis.

Points to Remember

• Mitral valve prolapse is a common condition affecting between 3 percent and 5 percent of patients. Those with mitral prolapse and greater than moderate to severe mitral regurgitation require valve repair to avert irreversible heart damage.
• More than 99 percent of Mayo Clinic patients with pure mitral valve regurgitation due to degenerative mitral leaflet prolapse undergo valve repair rather than prosthetic valve replacement.
• The discomfort and recovery time associated with traditional median sternotomy may discourage some patients from seeking needed treatment.
• A minimally invasive robotic repair alternative is now being used to treat patients with mitral valve disease and other heart conditions at Mayo Clinic.