CORRESPONDING AUTHOR:
Eugene A. Grossi, MD
Stephen B. Colvin Professor of Cardiothoracic Surgery
Director, Cardiac Surgery Research
Department of Cardiothoracic Surgery
NYU Grossman School of Medicine
Email:
Eugene.Grossi@nyulangone.org
CONFLICT OF INTEREST STATEMENT: Dr. Eugene A. Grossi has
intellectual property and receives royalties from Medtronic for valve
repair devices, and has intellectual property and receives royalties
from Edwards Lifesciences.
ARTICLE WORD COUNT: 253 words (excluding references, tables,
and legends)
COMMENTARY: Slow and steady wins the race – Building a Robotic
Mitral Valve Program
This review of 7 years of a single center’s experience with robotic
mitral valve repair (RMVr) by Klepper and colleagues is a testament to
the importance of dogged persistence in the pursuit of exceptional
outcomes. Multiple studies have demonstrated that it is possible to
achieve comparable results with RMVr, even in complex disease.[1, 2]
However, widespread adoption of RMVr has been discouraged by some owing
to reports of longer operative times, steep learning curves, and higher
operating costs. This manuscript serves as a blueprint for building an
outstanding RMVr program while preserving excellent results and
improving operative efficiency.
A critical aspect of this study was the decision to maintain strict
inclusion criteria in the initial cohort of patients. At the beginning
of the study, the authors only included patients for whom a simple MVr
was anticipated (i.e. single scallop prolapse). Importantly, this
definition of MVr complexity is consistent with the ACC/AHA Guidelines
for the Management of Patients with Valvular Heart Disease.[3] As
their familiarity with the robotic platform improved over time, the
authors gradually expanded their inclusion criteria to incorporate
patients with more complex mitral pathologies (e.g.
anterior/bileaflet/multi-scallop prolapses, extensive Barlow’s disease).
Importantly, all patients underwent successful RMVr without the need for
mitral valve replacement.
The authors are to be commended for a comprehensive report of their
initial experience with RMVr. Their obvious keys to success include
teamwork, focus, and progression of case difficulty, with an unyielding
standard of excellence.