Robotic Totally Endoscopic Aortic Valve Replacement and Mitral Valve Repair

In this new CTSNet President’s Series, Dr. Husam Balkhy, president of ISMICS, showcases cutting-edge, totally endoscopic cardiac procedures from the University of Chicago. Watch for more videos in this series coming soon.   

Robotic 8 mm ports were placed in the following sequence: the left arm in the second intercostal space (ICS), the camera port in the third ICS, the right arm in the fifth ICS, and the arm for the robotic retractor in the fifth ICS parasternally. An 8 mm working port for delivering sutures and the ring was positioned in the third ICS. A transthoracic aortic clamp was inserted in the second ICS. Cardiopulmonary bypass was established by femoral cannulation. Cardiac arrest was obtained using del Nido solution. First, the left atrium was opened, and the mitral valve was exposed with the atrial retractor. A semi-rigid partial annuloplasty ring was placed using a 3-0 Prolene running mattress suture technique. Next, a transverse aortotomy was made. Aortic valve leaflets and calcium on the annulus were excised. The left arm port was temporarily removed, and the incision was extended to accommodate the rapid-deployment aortic valve sizer. After sizing, stay sutures were placed in the nadir of each cusp. Then, the rapid-deployment valve was introduced through the left arm incision site and deployed in the annulus. The valve was inflated with a balloon. Aortotomy and left atriotomy were closed with 4-0 Prolene running sutures. Postoperative transesophageal echocardiography showed a well-seated rapid-deployment valve and no significant mitral regurgitation. 

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