LVOT modification during robotic mitral valve repair limits complications
Left ventricular outflow tract (LVOT) modification during robotic mitral valve repair (MVr) may help reduce the risk of serious complications, according to new research published in The Annals of Thoracic Surgery.[1]
Surgical mitral valve repair has been established as the gold standard treatment for patients presenting with severe degenerative mitral valve regurgitation (MR),” wrote first author Didier F. Loulmet, MD, a cardiothoracic surgeon with NYU Langone Health, and colleagues. “To be considered successful, MVr should restore normal leaflets motion and coaptation to alleviate any regurgitation without creating any stenosis or other technical complications such as paradoxical systolic anterior leaflet motion (SAM).”
Loulmet et al. explored data from 800 patients with degenerative MR who underwent robotic MVr from January 2019 to May 2024. The mean age was 63.8 years old, and 5.6% had a history of prior cardiac surgery. Patients diagnosed with SAM or hypertrophic obstructive cardiomyopathy prior to treatment were excluded. All procedures were performed by a team of two surgeons at a high-volume academic care center.
After a transesophageal echocardiogram, a multidisciplinary care team categorized each patient based on their post-operative risk of SAM; 76.2% faced a low risk, 18% faced a moderate risk and 5.8% faced a high risk. During robotic MVr, 73.2% of patients who faced a moderate or high risk of SAM and 6.9% of patients who faced a low risk of SAM underwent LVOT modification via ventricular septal bulge myectomy and/or septal myocardial trabeculation resection. The anterior leaflet was never detached.
Overall, LVOT modification increased the mean clamp time by 13 minutes. Patients who underwent LVOT modification did not face an increased risk of anterior leaflet injuries or iatrogenic ventricular septal defects. No patients required intraoperative repair revision due to SAM. One patient on inotrope did experience “transient SAM,” but it resolved as they stopped taking inotrope.
After 30 days, the group added, the mortality rate was 0.5% for both patients who underwent LVOT modification and those who did not.
“Despite a significant proportion of patients undergoing repair for degenerative MR with an elevated risk of postoperative SAM, we demonstrate that LVOT modification performed through a transmitral approach are associated with minimal morbidity and no requirements for subsequent revision of the initial repair for the complication of SAM,” the authors wrote.
Click here to read the full analysis in The Annals of Thoracic Surgery, a journal from The Society of Thoracic Surgeons.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.