Optimizing outcomes of robotic mitral valve repair for all prolapse anatomy: the Suri-Burkhart technique.

Early mitral valve (MV) repair is the evidence-based care standard for those with severe degenerative MV regurgitation and has been shown to improve long-term patient outcomes in comparison to non-surgical management (1). Despite evidence favoring the performance of MV repair prior to symptom onset or the appearance of left ventricular (LV) dysfunction, some physicians are hesitant to refer asymptomatic patients for MV repair involving traditional median sternotomy (2). Alternatively, cardiac surgical procedures including MV repair performed through small incisions utilizing videoscopic assistance are now common-place, and have been shown to be capable of sparing patients the physiological challenge of recuperating from a sternum-dividing operation (3,4). The spectrum of benefits potentiated by use of minimally invasive incisions is well documented in the literature (5). Several large health care delivery systems have embraced minimally invasive surgical approaches aiming to replicate the “gold standard” results of a trans-sternal (open) MV repair aiming to improve patient acceptance and facilitate earlier referral. This thereby minimizes the delayed but substantial costs associated with the evolution of chronic debilitating heart failure or the poor outcomes of rescue surgery once symptoms or LV dysfunction develop (3,6). Recent efforts to uphold the safety and efficacy of standard open operations while decreasing costs have launched robotic MV repair to the forefront of available treatment options for asymptomatic mitral regurgitation (MR).