Redo Robotic Mitral Valve Replacement Using Aortic Cross-Clamping

The authors report a redo robotic-assisted mitral valve replacement (MVR) in a 50-year-old male with prior bioprosthetic MVR via sternotomy, presenting with New York Heart Association (NYHA) class III dyspnea and significant prosthetic mitral inflow obstruction (mean/peak gradient 10/20 mmHg) with preserved biventricular function. The procedure was performed using a robotic platform with del Nido cardioplegia for myocardial protection, and a mechanical prosthesis was implanted based on the patient’s preference. 
 
While most robotic mitral procedures employ an endo-aortic balloon for aortic occlusion (1), its current unavailability in India necessitated an alternative strategy. The surgeons utilized a Chitwood transthoracic cross–clamp to achieve aortic occlusion. Although the use of the Chitwood cross–clamp has been described in thoracoscopic redo mitral surgery (2), its application on a robotic platform has not been reported. Careful circumferential aortic dissection enabled safe clamp placement, demonstrating a feasible and reproducible approach facilitated by superior robotic visualization and precise adhesiolysis. 

References

1. Murphy DA, Moss E, Miller J, Halkos ME. Repeat Robotic Endoscopic Mitral Valve Operation: A Safe and Effective Strategy. Ann Thorac Surg. 2018 Jun;105(6):1704-1709. doi: 10.1016/j.athoracsur.2018.01.018. Epub 2018 Feb 2. PMID: 29410099.
2. Liu J, Wei P, Ma J, Fang L, Chen Z, Cao Z, Liu F, Liu Y, Tan T, Wu H, Huang H, Chen J, Zhuang J, Xie B, Guo H. Propensity-matched analysis of two port approach versus three port approach for totally thoracoscopic mitral valve replacement. J Thorac Dis. 2020 Oct;12(10):5986-5995. doi: 10.21037/jtd-20-2901. PMID: 33209431; PMCID: PMC7656324.

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