Native mitral valve endocarditis: Robotic cardiac surgical repair

Abstract

Central MessageMitral valve repair in native valve endocarditis is often a challenging procedure. Robotic cardiac surgery is a safe approach and can be an asset for valve reconstruction, especially in complex cases. Mitral valve repair in native valve endocarditis is often a challenging procedure. Robotic cardiac surgery is a safe approach and can be an asset for valve reconstruction, especially in complex cases. Mitral valve (MV) endocarditis is associated with a high mortality rate and the need for surgical treatment. When possible, MV repair (MVr) is preferable to replacement.1Otto C.M. Nishimura R.A. Bonow R.O. Carabello B.A. Erwin III, J.P. Gentile F. et al.2020 ACC/AHA Guideline for the management of patients with valvular heart disease: a report of the American college of cardiology/American heart association joint committee on clinical practice guidelines.Circulation. 2021; 143: e35-e71PubMed Google Scholar,2Solari S. Navarra E. de Kerchove L. El Khoury G. Mitral valve repair for endocarditis.J Cardiac Surg. 2022; 37: 4097-4102Crossref PubMed Scopus (4) Google Scholar A robotic approach might prove to be a useful asset in cases requiring complex valve reconstruction.2Solari S. Navarra E. de Kerchove L. El Khoury G. Mitral valve repair for endocarditis.J Cardiac Surg. 2022; 37: 4097-4102Crossref PubMed Scopus (4) Google Scholar, 3Suri R.M. Dearani J.A. Mihaljevic T. Chitwood Jr., W.R. Murphy D.A. Trento A. et al.Mitral valve repair using robotic technology: safe, effective, and durable.J Thorac Cardiovasc Surg. 2016; 151: 1450-1454Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar, 4Chi N.H. Huang C.H. Huang S.C. Yu H.S. Chen Y.S. Wang S.S. et al.Robotic mitral valve repair in infective endocarditis.J Thorac Dis. 2014; 6: 56-60PubMed Google Scholar A previously healthy 31-year-old woman was admitted due to persistent fever and shortness of breath that began after a dental procedure. Transesophageal echocardiography (TEE) revealed a 10 mm vegetation in the MV. After initial unsuccessful antibiotic treatment with ceftriaxone and gentamicin, therapy was changed to daptomycin and meropenem. All cultures remained negative during the entire treatment course. After 30 days, the new TEE showed severe MV regurgitation with thickening of the P2 segment and a ruptured chord in the P3 segment. There was also a large vegetation in the A3 segment. This was compatible with MV endocarditis. There were no signs of perivalvular complications. Biventricular systolic function and dimensions were preserved. After multidisciplinary discussion by members of the endocarditis team, surgical treatment was indicated. The patient strongly wished for a minimally invasive approach. Because we are Latin America's first cardiac surgery service with more than 10 years' experience in robotic MVr, she was referred for our evaluation. Robotic-assisted cardiac surgery was deemed the best approach to facilitate MVr and provide a faster recovery.3Suri R.M. Dearani J.A. Mihaljevic T. Chitwood Jr., W.R. Murphy D.A. Trento A. et al.Mitral valve repair using robotic technology: safe, effective, and durable.J Thorac Cardiovasc Surg. 2016; 151: 1450-1454Abstract Full Text Full Text PDF PubMed Scopus (70) Google Scholar, 4Chi N.H. Huang C.H. Huang S.C. Yu H.S. Chen Y.S. Wang S.S. et al.Robotic mitral valve repair in infective endocarditis.J Thorac Dis. 2014; 6: 56-60PubMed Google Scholar, 5Montanhesi P.K. Curcio S.A.F. Poffo R. Robotic mitral valve surgery in Latin America.Ann Cardiothorac Surg. 2022; 11: 540-542Crossref PubMed Scopus (1) Google Scholar The patient was fully informed of all treatment options available, and a consent form for publication was signed under Research Ethics Committee Registry No. 11/1501–02/2011. The patient was positioned for a standard robotic mitral valve repair (Video 1), and incision markings were made considering the presence of a breast prosthesis, as shown in Figure 1. After systemic heparinization, peripheral ca