If you have been recommended to undergo mitral valve repair, you may wonder whether it always requires traditional open-heart surgery. Not necessarily.
Robotic mitral valve repair (robot-assisted mitral valve repair surgery) is a minimally invasive approach that uses small chest incisions, a high-definition camera and robotic surgical instruments to repair the mitral valve.
Unlike traditional open-heart surgery, robot-assisted mitral valve repair surgery does not make a large incision through the breastbone; instead, the surgeon operates through small openings between the ribs.
However, robot-assisted repair surgery is not suitable for everyone. A cardiac surgeon in Mumbai will make the final decision based on your heart condition, valve anatomy, overall health and whether you need other heart procedures.
What Is Robotic Mitral Valve Repair?
Robotic mitral valve repair is a type of minimally invasive mitral valve surgery used to repair a damaged mitral valve without a traditional full sternotomy.
During robotic valve surgery, the cardiac surgeon uses a robotic system to control small instruments inserted through several small chest incisions. A tiny camera gives a magnified, high-definition 3D view of the heart.
What is a Mitral Valve?
Your mitral valve is located between your upper and lower left heart chambers. It opens to allow blood flow from your left atrium to your left ventricle. When it closes, it prevents blood from moving backwards.
Sometimes, your mitral valve does not work properly because it’s too narrow or leaky. When the valve does not close properly, blood can leak backwards. This is called mitral valve regurgitation. In other cases, the valve may become narrowed, a condition known as mitral stenosis. This can give your heart a hard time pumping blood to your body.
Read Also: What Is Robotic Heart Surgery and How Does It Work
Robotic vs Traditional Mitral Valve Repair
Here are the main differences:
| Feature | Robotic Mitral Valve Repair | Traditional Open Surgery |
| Chest access | Small incisions between ribs | Larger chest incision, usually sternotomy |
| Breastbone | Usually not divided | Usually divided |
| Surgical view | Magnified 3D camera view | Direct surgical view |
| Instruments | Robotic, wrist-like instruments | Conventional surgical instruments |
| Heart-lung bypass | Usually required | Usually required |
| Scarring | Smaller incisions | Larger central chest scar |
| Recovery | Often faster | Generally longer |
Which approach is appropriate for you will depend on the patient’s condition and the surgeon’s assessment.
Read Also: Robotic vs. Open-Heart Surgery: What Patients Need to Know
Why Might You Need Mitral Valve Repair?
Mitral valve repair may be considered for conditions such as:
- Mitral valve regurgitation
- Mitral valve prolapse
- Mitral valve stenosis
- Damaged or ruptured valve-supporting chords
- Certain valve problems caused by infection or calcium deposits
Not everyone with mitral valve disease requires surgery. Mild disease may sometimes be monitored with regular echocardiograms and managed as per the underlying condition.
How Is Robotic Mitral Valve Repair Performed?
The procedure follows the same basic goal as conventional mitral valve repair: preserve your natural valve and restore its normal function.
1. Anaesthesia is given
You are placed under general anaesthesia, so you remain asleep throughout the procedure.
2. Small chest incisions are made
Instead of opening the breastbone, the cardiac surgical team makes several small openings on the right side of the chest, usually between the ribs.
These openings give access for the camera and surgical instruments.
3. The heart-lung machine takes over
A cardiopulmonary bypass machine temporarily performs the work of the heart and lungs.
This allows the surgeon to stop the heart briefly and work safely on the mitral valve.
4. The surgeon views the heart in 3D
A small high-definition camera, or thoracoscope, provides a magnified view of the heart.
The surgeon sits at a nearby console and controls the robotic instruments using hand movements.
The robotic instruments can make precise movements that are especially useful when working in the confined space around the mitral valve.
5. The mitral valve is accessed
The surgeon opens the left atrium to reach the mitral valve.
The exact repair depends on what is wrong with the valve.
6. The valve is repaired
Different techniques may be used.
For example:
- If part of a valve leaflet is prolapsing, the surgeon may remove the damaged section and bring the healthy edges together.
- If the supporting chords are damaged or stretched, the surgeon may create and attach neochords, which act like replacement support strings.
- An annuloplasty band or ring may also be placed around the valve to restore its shape and support the repair.
Common Repair Techniques
| Repair technique | What it does |
| Annuloplasty | Supports and reshapes the valve opening |
| Leaflet resection | Removes a damaged or excessive section of leaflet |
| Chordal repair | Repairs or replaces damaged supporting chords |
| Neochords | Creates new artificial chords to support the leaflet |
| Calcium removal | Removes problematic calcium deposits in selected cases |
7. The repair is tested
Before completing the procedure, the surgical team checks whether the repaired valve is working properly.
Transesophageal echocardiography may be used to examine the valve and look for any significant remaining leakage.
Once the repair is satisfactory, the heart is allowed to resume normal activity, and you are gradually taken off the heart-lung bypass machine.
Recovery After Robotic Mitral Valve Repair
The recovery from mitral valve repair surgery usually takes 4 to 8 weeks. Some individuals may need longer. A minimally invasive approach may allow a faster recovery than traditional open surgery for suitable people, but your actual recovery time can be different.
Recovery depends on factors such as overall health, the complexity of the repair and whether other procedures were performed.
What Are the Advantages of Robotic Mitral Valve Repair?
If you meet the criteria to undergo robot-assisted mitral valve repair surgery, it can offer you and your cardiac surgeon the following potential benefits:
Advantages for Eligible Patients
- Smaller chest incisions.
- Less disruption to the breastbone.
- Less postoperative pain for some patients.
- Reduced visible scarring.
- Shorter hospital stay in appropriate patients.
- Faster return to normal activities in many cases.
Advantages for the Surgeon
- With the surgical robot, your surgeon will insert tiny surgical tools and cameras through one or more small chest incisions.
- Magnified, high-definition view of the surgical area.
- Precise control of surgical instruments.
- Greater dexterity and range of motion of the robotic instruments.
- Better visualisation of the mitral valve and surrounding structures.
- Ability to perform complex valve repair via smaller access points.
Note: It is important to remember that these benefits can differ from person to person.
What Are the Different Techniques Used for Repairing the Mitral Valve?
Surgical techniques for mitral valve repair rely on 5 core reconstructive methods to reshape and restore valve function.
- Annuloplasty
- Triangular or quadrangular resection
- Sliding plastica (sliding repair)
- Artificial chordae (chordal replacement)
- Commissuroplasty
Surgical access approaches used are:
- Traditional open surgery
- Minimally invasive surgery via specialised video equipment or a robotic assist system
- Transcatheter repair
FAQs About Robotic Mitral Valve Repair
Is robotic mitral valve repair safe?
Yes, after proper assessment of eligibility criteria, robot-assisted mitral valve repair surgery is a safe and effective procedure when performed by experienced surgical teams.
However, like every heart surgery, robotic mitral valve repair carries risks and can have possible complications, including bleeding, infection, abnormal heart rhythms, blood clots, stroke, heart block, heart or lung complications, and the need for additional surgery.
Can a mitral valve be repaired without open-heart surgery?
Yes. Your surgeon may repair your mitral valve using minimally invasive and robotic approaches, depending on your diagnosis and the condition of your heart and valve.
Who can have robotic mitral valve repair?
People with severe mitral valve disease, such as mitral valve prolapse, regurgitation, or degenerative valve conditions, may be recommended for robotic mitral valve repair.
The final decision is based on factors such as:
- The type and severity of mitral valve disease
- The exact anatomy of the valve
- Heart function
- Previous heart or chest surgery
- Other medical conditions
Conclusion
If you ask, is robotic mitral valve repair better than open surgery? There is no single approach that is best for every patient with mitral valve disease. Robot-assisted mitral valve repair surgery may offer benefits such as smaller incisions and potentially faster recovery in appropriately selected patients, while traditional surgery may be more suitable for certain complex cases.
Therefore, all you need to do is make an informed decision with your doctor to determine whether robotic, minimally invasive or conventional mitral valve surgery is appropriate for you.
Disclaimer: This blog is for informational purposes only. For accurate information about robotic mitral valve repair, contact your doctor.
