Pavan Atluri, MD, director of minimally invasive and robotic cardiac surgery at Penn Medicine, reviews advantages of minimally invasive techniques for mitral regurgitation. Dr. Atluri uses case footage to review the Penn approach to robotic mitral valve repair.
Related Links: Dr. Atluri's physician profile
Good morning. It's my pleasure to talk to you this morning about robotic micro valve surgery at the University of pennsylvania. I know we have a very brief presentation here limited to five minutes. So after at the end of the presentation I'd be happy to talk to anybody um either by phone, email etcetera. With any questions that you may further have. The advantage is a minimally invasive approaches for mitral regurgitation have been well documented and include rapid recovery including lengths of stay, excavation, return and return to activity. Limited blood transfusion requirements have been demonstrated as has decreased pain and Kaz missus. Additionally, there's suggestions of improvements and rates of atrial fibrillation utilizing these advantages, we have um couple this with the maintenance of long term outcomes which is the primary objective of any mitral valve operation. We know that Mitral Valve durability can last out well beyond 20 years. Has been demonstrated by multiple studies including this landmark study from Toronto. Therefore at the University of pennsylvania we believe in utilizing durable techniques including the same techniques. We would do its anatomy minimally invasively to ensure long term durability of repair. This I assure you is the primary tenant of any operation that we produce perform at the University of pennsylvania. Um Are inter operative cannula setup includes a per catania's P. A catheter as well as S. V. C. Drain is shown here on the left. A limited 1.5 centimeter incision in the growing, thereby exposing the femoral vessels. We utilize an endo aortic balloon um to um occlude the ascending aorta internally as is demonstrated here and separate the heart from circulation, allowed for very reproducible delivery of cardio please. Jah! Our incision includes a limited, roughly 3.5 centimeter ah lateral, right sided thoracotomy as well as the ports demonstrated here. It can look pretty busy bedside, but at the end of the day heels absolutely beautifully and provides for really wonderful access and visualization of the mitral valve. Nearly all pathologies can be well managed minimally invasively. Procedure itself and I will be skipping ahead in the interest of time, involves opening the pericardium which is done very easily with the robot pericardium is retracted and the the intria atrial group has developed and the left atrium is entered. Once entered via Syndergaard's groove, a tree Autumn is extended and the mitral valve was exposed utilizing a dynamic left atrial tractor. We then do a very classic repair technique again, same as we would turn on to me here you see a triangular section being performed on a posterior leaflet prolapse. The defect is then closed with interrupted CV five Gortex futures, much like we would through eastern artemis approach. Following closure of the defect. Annual plastic sutures are placed and this is actually not trivial and critical that is well placed, including perfect alignment of the trig owns to ensure good long term durability of valve repair and stability of annual plastic device. We spend quite some time making sure that we have perfect sutures within these trig owns where the fibers portions of the heart exist. Once the annual plastic futures are placed again placed just like we would through astronomy. Annual plastic device is then seated and secured. The left atrium is then closed in a fairly straightforward fashion with interrupted suture and the patient is then weaned from cardiopulmonary bypass. Other procedures can also be performed, including maxima's here. You see the placement of a trick, your um left atrial appendage clip, which you see is that the appendages delivered through the sinus. The clip is then applied around the appendage and released when you see what good and excellent placement of that clip with total isolation of the appendage. Of course the full left sided and right sided cox aims for lesion set can be performed. Our traditional lesion set includes lesions, the coronary, sinus, mitral annular pulmonary vein isolation as well as left atrial appendage on the left side with adjunctive, right sided lesions including Intercable lesion, right atrial appendage as well as try daniel. We utilize an a trick your cryo probe for this technique. Incisions heal rather beautifully in the postoperative period. We utilize an earache protocol uh including um Neurontin ivy Tylenol, Um regional nerve block of two inter spaces above and below, reel laterally utilizing episode of cocaine and then adjunctive toward all the combination of this keeps the patient's quite comfortable for at least 48 hours and allows for a smooth recovery. Yeah, hopefully you've got a nice overview or robotic technique and our focus on optimal outcomes with minimally invasive approaches. A smooth recovery for our patients. Please feel free to reach out to me, as I said earlier with any questions, I hope you're enjoying the conference and look forward to talking to all of you in the future.
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