Robotic Mitral Valve Repair: What Have We Learned After 2,000 Operations?
Written By: Adam Pick, Patient Advocate & Author
Medical Experts: Marc Gillinov, MD, Chairman of the Department of Cardiothoracic Surgery, Cleveland Clinic, and Daniel Burns, MD, Minimally-Invasive Cardiac Surgeon, Cleveland Clinic
Published: September 12, 2023
Patient interest in robotic mitral valve repair surgery continues to grow. As a result, my inbox receives many questions about the use of “robot-assisted” approaches that treat severe mitral regurgitation and other cardiac conditions using minimally-invasive techniques.
To learn more, we connected with Dr. Marc Gillinov, the Chairman of the Department of Cardiothoracic Surgery at Cleveland Clinic, and Dr. Daniel Burns, Minimally-Invasive Cardiac Surgeon at Cleveland Clinic, after the Cleveland Clinic completed its 2,000th robotic mitral valve repair operation.
Key Learnings About Robotic Mitral Valve Repair
Here are important highlights from the interview with Drs. Gillinov and Burns:
- Robot-assisted mitral valve repair surgery can provide advantages for both the patient and the surgeon. “For the patient, smaller incisions, quicker recovery and no big incision on the chest,” states Dr. Gillinov. “From the surgeon perspective, we have an incredibly accurate high-definition camera such that we have unparalleled views of the valve. Couple this outstanding exposure and view with the robotic instruments, which enable us to do anything with the robot that we could have done with our hands, you get a winning combination.”
- There are limitations to what the robot can do and when the robot can be used. “We have to be mindful that we cannot do a full spectrum of cardiac surgical cases with the robot,” states Dr. Burns. “For instance, a patient’s aortic valve has to be competent to allow for proper protection of the heart during the surgery, and also to prevent over-distention of the left ventricle, potentially leading to disfunction after the surgery. We also have to be mindful that the patient’s aorta has to be relatively free of calcium and plaque burden to minimize the stroke risk during the surgery.”
- The Cleveland Clinic team has learned how to safely and effectively use the robot to treat other cardiac disorders during mitral valve repair surgery including, atrial septal defects, Patent Foramen Ovale, tricuspid valve repair, and atrial fibrillation (e.g. Maze procedure).
- There is an extensive learning curve to develop the expertise needed to use the robot during a mitral valve repair surgery. When evaluating a potential robotic mitral valve surgeon and medical team, patients should ask several critical questions including, “What is your robotic experience?”, “Do you have a dedicated team?”, and “What are your results?”
- The Cleveland Clinic has performed over 2,000 robotic mitral valve repair procedures with outcomes including a surgical mortality risk of less than 1%, a surgical repair success rate of 99.5% and stroke risk of less than 1%.
Thanks Dr. Gillinov, Dr. Burns & Cleveland Clinic!
On behalf of our entire patient community, many thanks to Dr. Gillinov and Dr. Burns for sharing their clinical experience and research with our community! Also, many thanks to Cleveland Clinic for taking such great care of heart valve patients.
- Robotically Assisted Mitral Valve Repair: Procedure Details, How It Works
- Recovery & Outlook After Robotically-Assisted Mitral Valve Repair
Keep on tickin!
P.S. For the deaf and hard of hearing members of our community, I have provided a written transcript of this interview below.
Dr. Marc Gillinov: I’m Marc Gillinov, Chair of the Department of Thoracic and Cardiovascular Surgery at the Cleveland Clinic.
Dr. Daniel Burns: I’m Dr. Daniel Burns, Staff Surgeon at the Cleveland Clinic. I specialize in robotic and minimally invasive mitral valve surgery.
Dr. Marc Gillinov: Today, we’re going to talk a little bit about robotic surgery, specifically, robotic mitral valve surgery and our experience here at the Cleveland Clinic with more than 2,000 patients who’ve had robotic mitral valve surgery. Many times people ask, why do you, the surgeons, do robotic mitral valve surgery? What are the advantages? There are a few advantages.
The first is, for the patient, of course, smaller incision, quicker recovery, no big incision on the chest. From the surgeon perspective, we have an incredibly accurate high-definition camera such that we have, with the robot, unparalleled views of the valve. Couple this outstanding exposure and view with the robotic instruments, which enable us to do anything with the robot that we could have done with our hands, you get a winning combination that lets us fix the valve through very small incisions.
Dr. Daniel Burns: Though there are numerous advantages to using the robot, we have to be mindful that we cannot do a full spectrum of cardiac surgical cases with the robot and also that there are some things that we have to be quite mindful of. For instance, a patient’s aortic valve has to be competent to allow for proper protection of the heart during the surgery, and also to prevent overdistention of the left ventricle, potentially leading to disfunction after the surgery.
We also have to be mindful that the patient’s aorta has to be relatively free of calcium and plaque burden to minimize the stroke risk during the surgery. There are numerous things that we can also add to a robotic mitral valve surgery, things like atrial septal defects, or Patent Foramen Ovale, tricuspid valve repair, atrial ablation procedures, or Maze procedures, for the treatment of atrial fibrillation.
Dr. Marc Gillinov: When a patient comes to us for mitral valve surgery, and potentially robotic mitral valve surgery, I think there are a few questions that the patient should ask the surgeon. First and foremost, what has been your experience, your institution’s, your surgeon’s experience with the robot? This is an important question because there is a substantial learning curve to using the robot. We are fortunate that we’re thousands of cases into our learning curve, and we’ve developed expertise such that now a robotic mitral valve operation is routine. It doesn’t take that long, goes well, and we have also a team of people that is skilled and trained with the robot.
That gets to the second question. Do you have a team that is specifically dedicated to robotic surgery? Finally, you want to know, if you’re the patient, what are your surgeon’s and surgical team’s results? How have they done? What are the risks? What is their repair rate? The operative risk for a robotic mitral valve operation should be close to zero. This is an operation that can be done such that virtually every single patient does well. The repair rate, the ability to repair the valves that we intend to repair, should be 99% or greater. These are the key questions to ask your surgeon.
Dr. Daniel Burns: At the Cleveland Clinic, we have the benefit of having performed over 2,000 robotic assisted mitral valve procedures; because of this experience, we have now achieved a surgical mortality risk of less than 1%, and a surgical repair success rate of 99.5%. This is coupled, also, with a very low risk of concomitant complications. For instance, our stroke risk is less than 1% as well. Our goal is to not only perform an excellent and durable mitral valve operation, but to give the maximum patient safety during the course of the procedure and afterwards.
Dr. Marc Gillinov: Robotic mitral valve surgery is a highly complex endeavor that requires a super experienced team. If you are contemplating this approach for yourself, and for your own mitral valve, it behooves you to find a surgeon and a surgical team that has dedication and expertise to ensure that when you leave that hospital you are well, you have a repaired valve, and you’re going to have a quick and excellent recovery.
Adam Pick: Hi, everybody, it’s Adam. I hope you enjoyed that video. Don’t forget, you can always subscribe to our YouTube channel. Watch the next two educational videos coming up on your screen or click the blue button to visit heartvalvesurgery.com.