Robot-assisted minimally invasive mitral valve repair at Mayo Clinic

In robot-assisted mitral valve repair surgery at Mayo Clinic, two board-certified cardiac surgeons use robotic equipment to perform the exact same procedure conducted in traditional open chest heart surgery, without needing to make a large incision through your breast bone. Your surgeons perform the procedure through small incisions in your right chest, using finger-sized instruments that are slipped in between your ribs. In this procedure, one surgeon sits at a remote console and views your heart using a magnified high-definition 3D view on a video monitor. Another surgeon works at the operating table and ensures the safe movement of the robotic arms. You’ll need to be supported by a heart-lung bypass machine during the procedure. This will allow your surgeons to stop your heart briefly and insert instruments into the inner chambers to repair the mitral valve. Your surgeon uses robotic arms to duplicate specific maneuvers used in open-chest surgeries. The procedure is performed through small openings in your chest, through which will be inserted micro instruments and a thin high-definition camera tube or thoracoscope. One opening will be a mini working port through which surgeons will insert materials used during the procedure. Your surgeon performs the procedure from the remote console. Your surgeon’s hand movements are translated precisely to the robotic arms at the operating table, which move like a human wrist. At the operating table, another surgeon works together with the surgeon at the console to perform the procedure and ensure it is conducted safely and efficiently. Your surgeon at the console can closely examine the complicated mitral valve problem using the high-definition 3D video monitor. This allows your surgeon to have a clearer, more lifelike perspective of your heart than is possible during open heart surgery, in which surgeons view the heart from a further distance.

To repair the mitral valve, your surgeon makes an incision in the left upper chamber or left atrium of your heart to access the mitral valve. Your surgeon can then identify the problem with your mitral valve and repair the valve itself. In mitral valve prolapse, the mitral valve, located between your heart’s left atrium and the left lower chamber or left ventricle, doesn’t close properly. The leaflets of the valve bulge or prolapse upward or back into the left atrium as your heart contracts. This leads to blood leaking backward into the left atrium, a condition called mitral valve regurgitation. To repair this condition, various complicated technical procedures are performed. Sometimes a small section of the leaflet, the part of the valve that doesn’t close properly, is identified, and a triangular section is removed, as shown.  Your surgeon then stitches the cut edges of the leaflet together to repair the valve.

In other cases, new chords or chordae supporting the broken leaflet are inserted. An annuloplasty band is then placed around the circumference of the valve to stabilize the repair. Your surgeon will close the incisions in your chest after the procedure. Mayo’s staff will assist you during your recovery over a three-day period in the hospital. In robot-assisted heart surgery, most people have a quicker recovery, smaller incisions, and less pain than following open-chest surgery. Studies have also found that this procedure performed at Mayo Clinic is cost effective, with similar or lower total costs compared with traditional open-chest surgery.

Sept. 24, 2021

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