Cardiothoracic surgeons at UC San Francisco performed the first robotically assisted mitral valve prolapse surgery in San Francisco.
Reporter: Aviva Lev-Ari, PhD, RN
UPDATED on 1/15/2025
Robotic mitral repair compares favorably to surgery—but some concerns remain
Hoping to learn more about how robotic mitral repair compares with surgery, Benharash et al. examined data from more than 40,000 patients who underwent treatment from 2016 to 2020. Nearly 10% of those patients underwent robotic mitral repair. The median ages for the two groups were nearly identical—approximately 61 years old—but robotic mitral repair patients were more likely to be men, have private insurance coverage and belong to the highest income quartile. These patients were also less likely to present with certain comorbidities, including chronic lung disease, end-stage renal disease, peripheral vascular disease and pulmonary hypertension.
Overall, robotic mitral repair and surgery resulted in comparable rates of in-hospital mortality, stroke, blood transfusion, reoperation and hospital readmission. In addition, robotic treatment was associated with lower rates of pulmonary complications (6.1% vs. 8.1%), postoperative infection (1.7% vs. 3.4%) and acute kidney injury (AKI) (5.7% vs. 8.5%) as well as significantly shorter lengths of stay and a reduced chance of being discharged to another type of healthcare facility.
As one may expect, however, mean healthcare costs were considerably higher for robotic mitral repair ($53,600 vs. $45,200).
A team of specialists with Cedars-Sinai in Los Angeles, including veteran cardiac surgeon Alfredo Trento, MD, shared their perspective about this research in a separate editorial.[2] The group congratulated the authors for their work, highlighting the importance of learning more about this topic, but they also wrote shared some concerns about the study’s findings. The fact that robotic treatment was more commonly used to treat patients who earn a higher income, for example, suggests that the increased costs of robotic mitral repair could not necessarily be as beneficial for all patients.
“A health intervention that can only be performed at a handful of hospitals by a select group of individuals is not necessarily a good intervention as it is not generalizable and not applicable to most of the population,” the group wrote. “For cardiac surgery to remain relevant in the mitral realm, we must be able to offer safe, durable repairs in a noninvasive manner to as much of the population as possible.”
Original Research
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Mitral valve surgery is performed when the heart’s mitral valve needs to be repaired. Traditionally, mitral valve surgery required opening the chest and putting the patient on heart-lung bypass to keep blood circulating during surgery. Since 2016, UCSF surgeons have been performing minimally invasive mitral valve surgery without having to open the sternum and with smaller incisions. Robotically assisted mitral valve surgery adds yet another level of precision.
“Robotically assisted mitral valve surgery allows us to make even smaller incisions with greater precision,” said Tom C. Nguyen, M.D., robotic heart surgeon and chief of Cardiothoracic Surgery at UCSF. “By using the robotic arms, we have more degrees of articulation than with our natural wrists. The robot also magnifies the surgical field 10X in 3D. Ultimately, this translates into more precise surgery with faster recovery.”
During the robotically assisted surgery, the surgeon looks through a 3D camera to see the mitral valve as well as other structures inside the heart. The surgeon uses the robotic surgical system to guide the robotic arms and movements of the surgical instruments.
“Every valve looks different, and the extraordinary 3D vision that the robot camera provides, is just a real step up from all the technologies we have been using in the past,” said Tobias Deuse, M.D., cardiac and transplant surgeon and director of Minimally-invasive Cardiac Surgery. “The camera, together with the increased mobility of the instruments, allows for a very thorough evaluation of the valve and helps us make good and long-lasting repairs.”
Thanks to these innovations, mitral valve patients have fewer complications and can be discharged within three-to-four days. This patient’s symptoms included increased fatigue and palpitations. Since the surgery, he is at home and his recovery is going well.
In addition to mitral valve surgery, there are plans for additional robotically assisted cardiothoracic surgeries, including removal of intracardiac tumors and myxomas as well as for coronary revascularization.
SOURCE
https://www.universityofcalifornia.edu/news/ucsf-performs-first-robotic-cardiac-surgery-san-francisco?utm_source=fiat-lux&utm_medium=internal-email&utm_campaign=article-general&utm_content=text
Other robotic surgeries currently being performed at UCSF
encompass a wide range of specialties and procedures, including:
- removing cancerous tissue from the lungs, uterus, ovaries, colon, rectum, esophagus, bladder, prostate, head and neck, liver and pancreas. Other robotic surgeries are used for
- the treatment of uterine fibroids and endometriosis, female pelvic organ prolapse repairs,
- hernia repairs and
- bariatric surgery.
Other related articles on Mitral Valve Repair published in this Open Access Online Scientific Journal include the following:
Reporter: Aviva Lev-Ari, PhD, RN
The Patient for this historic procedure:
An 82-year-old man presenting with severe symptomatic tricuspid regurgitation (TR) and right heart failure (RHF).
Expert Opinion: The Voice of Dr. Justin D. Pearlman, MD, PhD, FACC
and another 64 articles
https://pharmaceuticalintelligence.com/?s=Mitral+valve
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