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 [3] coming soon. 

The first case involves an 82-year-old man who underwent MitraClip implantation for severe mitral regurgitation (MR) six months ago. The second case is a 75-year-old woman with a medical history of persistent atrial fibrillation, severe tricuspid valve regurgitation, and MitraClip implantation one year ago. Both patients had residual severe MR after MitraClip implantation and underwent robotic totally endoscopic mitral valve repair. 

Four 8 mm robotic ports and a working port were placed in the right chest. Cardiopulmonary bypass was established by femoral arterial and venous cannulation. Cardiac arrest was undertaken using an endoaortic balloon occlusion and del Nido solution. The left atrium was opened, and the mitral valve was exposed with a robotic dynamic atrial retractor. The clips were carefully excised with gentle blunt dissection while using care to preserve the leaflet tissue. The defects in the leaflets created by the clip were primarily closed using 4-0 single interrupted sutures. A semi-rigid partial annuloplasty ring was placed with 3-0 running mattress suture technique.  

In the second case, concomitant with mitral valve repair left atrial Cryo-Maze procedure was performed using a cryo-ablation probe for three minutes for each lesion. The left atrial appendage was closed with two layers of 4-0 running sutures. After closing the left atriotomy, the right atrium was opened, and the right atrial Cryo-Maze ablation was performed. An annuloplasty band was placed in the tricuspid valve with 3-0 continuous mattress suture. Postoperative transesophageal echocardiography showed no residual MR in both cases. 

Disclaimer

The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here. [4]