Robotic Repair of Mitral Commissural Endocarditis With a "Bridging Patch" Technique

Originally presented as an STSA/CTSNet Surgical Motion Picture at the 2016 STSA Annual Meeting. 

Objectives: Mitral valve reconstruction is now the primary surgical approach in mitral endocarditis, with better early and late outcomes than prosthetic valve replacement. However, certain pathologies can be difficult, and reports of extension to a robotic platform have been limited. This video illustrates robotic repair of mitral commissural endocarditis using a novel “bridging patch” technique.

Methods: A 20-year-old female college student presented with a febrile illness, heart failure, severe MR (with a posterior leaflet vegetation), and positive blood cultures for Streptococcus Viridans. After four days of intravenous penicillin, the patient underwent mitral valve repair, using a 4-port robotic system. The endocarditis had destroyed both the anterior and posterior leaflet tissue at the posterior commissure, and was associated with a large vegetation. Involved leaflet tissue was resected, which left a large defect at the posterior commissure. The defect was closed with a patch of fresh autologous pericardium that bridged the gap in the commissure and a #28 mitral ring was inserted.

Results: After repair, the valve was completely competent with a mean valve gradient of 4 mmHg. The patient recovered uneventfully, and resumed college with no cardiac symptoms.

Conclusion: In a difficult endocarditis situation affecting both mitral leaflets at the posterior commissure, successful robotic repair was achieved using a "bridging patch" technique. Normal valve function was restored, suggesting that this method could be useful in future cases of mitral commissural endocarditis.

Copyright 2016, used with permission from the Southern Thoracic Surgical Association. All rights reserved.