Robotic mitral valve repair âEndoballoon Method Endoballoon Method
Robotic mitral valve repair âEndoballoon Method Endoballoon Method
Robotic mitral valve repair âEndoballoon Method Endoballoon Method
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<strong>Robotic</strong> <strong>mitral</strong> <strong>valve</strong> <strong>repair</strong>–<strong>Endoballoon</strong> <strong>Method</strong>Tomislav Mihaljevic, MDDepartment of Thoracic andCardiovascular Surgery<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 1
DisclosuresTomislav Mihaljevic, MD•Consultant–Intuitive Surgical–Edwards Lifesciences–St. Jude Medical<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 2
•Pros:<strong>Endoballoon</strong> <strong>Method</strong>–Allows total endoscopic approach– Suitable for redos•Cons:–Cost– Complexity– Risk of neurologic and vascularcomplications<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 3
Preoperative Evaluation•Noncontrast chest and abdomen CT–Patients >50 y Morphology and calcification ofaorta and iliac vessels•Femoral ultrasound<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 5
Surgical Technique•Incisions and port placement•Cardiopulmonary bypass & myocardialprotection•Pericardiotomy•Atriotomy•Mitral <strong>valve</strong> <strong>repair</strong><strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 6
Surgical Technique•Incisions and port placement•Cardiopulmonary bypass & myocardialprotection•Pericardiotomy•Atriotomy•Mitral <strong>valve</strong> <strong>repair</strong><strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 7
<strong>Endoballoon</strong> <strong>Method</strong><strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 8
<strong>Endoballoon</strong> <strong>Method</strong><strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 9
Surgical Technique•Incisions and port placement•Cardiopulmonary bypass & myocardialprotection•Pericardiotomy•Atriotomy•Mitral <strong>valve</strong> <strong>repair</strong><strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 10
CPB and MyocardialProtection•Femoral arterial cannulation•Single venous cannulation•Aortic balloon occlusion•Percutaneous retrogradecardioplegia•Pulmonary artery vent (optional)<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 11
<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 12
<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 13
Surgical Technique•Incisions and port placement•Cardiopulmonary bypass & myocardialprotection•Pericardiotomy•Atriotomy•Mitral <strong>valve</strong> <strong>repair</strong><strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 14
Pericardiotomy<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 15
Aortic Occlusion with<strong>Endoballoon</strong><strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 16
Troubleshooting•Balloon migration– Increase perfusion pressure– Optimize venous drainage– Adenosine<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 17
Troubleshooting•Inadequate cardioplegia delivery– Reposition balloon– Exchange balloon– Convert to transthoracic crossclamp<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 18
Surgical Technique•Incisions and port placement•Cardiopulmonary bypass & myocardialprotection•Pericardiotomy•Atriotomy•Mitral <strong>valve</strong> <strong>repair</strong><strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 19
Atriotomy<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 20
Surgical Technique•Incisions and port placement•Cardiopulmonary bypass & myocardialprotection•Pericardiotomy•Atriotomy•Mitral <strong>valve</strong> <strong>repair</strong><strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 21
<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 22
<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 23
Anuloplasty running suture<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 25
<strong>Robotic</strong> Operations2006 –2010IN > 650<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 26
Mortality0%<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 27
Repair Rate99%<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 28
Conclusion•Endoscopic robotic endoballoon methodis the least invasive approach for MV<strong>repair</strong>• Requires dedicated and experiencedrobotic surgical team•Patient selection crucial determinant ofsuccess<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 29
Thank you<strong>Robotic</strong>allyassisted Cardiac Surgery l May 4, 2010 l 30
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