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2011 Spring Choosing Ablation to Treat AF

Heart & Vascular Institute Physician eNewsletter - Spring 2011

A study led by Tomislav Mihaljevic, MD, a thoracic and cardiovascular surgeon in the Sydell and Arnold Miller Family Heart & Vascular Institute compares outcomes of robotic mitral valve repair to those of conventional approaches. "The value of this study for cardiologists and patients who have heart disease is that it objectively validates the safety and quality of robotic surgery for mitral valve disease,"says Dr. Mihaljevic.

Dr. Mihaljevic and his colleagues looked at the outcomes of 759 patients with degenerative mitral valve disease and posterior leaflet prolapse who underwent primary isolated mitral valve surgery between 2006 and 2009. These patients received a complete sternotomy, partial sternotomy, mini-right anterolateral thoracotomy, or robotic approach.

Repair was achieved in all patients but one.  Quality of repair was similar among all groups. The complication rate among all groups was similar. Although the robotic surgeries took somewhat longer due to procedural complexity this was compensated for by lesser invasiveness. The robotic patients had the lowest occurrences of atrial fibrillation and pleural effusion. This contributed, along with the shorter healing time that comes with smaller incisions, to shortening the average hospital stay for the robotic patients. (Robotic surgery is the least invasive cardiac surgery technique.)

Cleveland Clinic surgeons performing robotically assisted surgery

Previous studies of robotic surgery have not compared the same operation performed by a minimally invasive method vs. a traditional, established approach. This study was the first of its kind and produced the highest ever reported repair rate in the world for MV robotic surgery: There were no in-hospital deaths. By contrast, the nationally reported mortality rate for mitral valve repair is 2.5 to 3 percent. "Ours is zero," says Dr. Mihaljevic.

The average reported repair rate for MV repair in the U.S. is no greater than 60 percent. Centers of Excellence have MV repair rates that average 90 percent. Cleveland Clinic's repair rate is greater than 99 percent.

Dr. Mihaljevic believes the study goes a long way toward setting any remaining controversy about the robotic approach. "There has been a fair amount of press that questions the value, safety and cost of robotic surgery,"says Dr. Mihaljevic. "A study that objectively validates the benefits of this technique has been long overdue. Robotic mitral valve repair should be considered for all patients with severe mitral valve prolapse.”

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Reviewed: 05/11

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