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Benefit Of Endoscopic Approach Using Robotics For A Redo Mitral Valve Replacement After Previous Sternotomy
Yuji Kawano, Michael Halkos, Douglas Murphy.
Emory St. Joseph's Hospital, Atlanta, GA, USA.

OBJECTIVE: Robotic-assisted approach in cardiac surgery has become one of well-established surgical approaches. Despite increasing numbers of centers performing robotic cardiac surgeries, this approach is usually applied to first-time operations. Only a few reports are found utilizing this approach in redo cases with previous sternotomy. Herein, we present a redo case successfully completed with our lateral endoscopic approach using robotics (LEAR).
METHODS: The patient is a 59-year-old male with history of previous mechanical aortic valve replacement, atrial fibrillation, myocardial infarction, and stage 4 chronic kidney disease. Preoperative echocardiogram showed severe mitral stenosis. STS risk of mortality was 17.4%. We performed reoperative mitral valve replacement (MVR) with LEAR technique.
RESULTS: The common femoral artery/vein were cannulated for the cardiopulmonary bypass (CPB). Robotic arm ports were placed safely. Adhesions were carefully dissected with robotic instruments. The ascending aorta was successfully occluded with the balloon occlusion device. 25mm mechanical valve was seated. After CPB was separated, all the cannulas were removed. The prosthetic valve function was normal with no perivalvular leak. The operative time was 301 minutes. CPB time and cross clamp time were 130 minutes and 100 minutes respectively. The patient was extubated in the operating room and was discharged home on the postoperative day four.
CONCLUSIONS: We successfully performed repoperative MVR using LEAR technique for a very high risk patient. Resternotomy is known as one of risk factors that complicates surgery. LEAR enables surgeons to approach the mitral valve with minimal adhysiolysis.This benefit can be maximized by utilization of an endoaortic occlusion balloon. Another benefit of this approach is the excellent visualization. With existence of a previous mechanical prosthesis, it would have been more challenging to obtain an adequate exposure of the mitral valve through sternotomy. This presentation indicates the safety and efficacy of LEAR for redo cases with previous sternotomy.


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