Feasibility of robotic-assisted mitral ring annuloplasty using the continuous wrapping suture technique: A single-center experience.

Objectives: Robotic-assisted mitral ring annuloplasty is safe and effective; however, the use of conventional interrupted suture may prolong operative time. This study retrospectively evaluated the safety and feasibility of continuous wrapping suture for annuloplasty in robotic-assisted mitral valve (MV) repair.

Methods: This study included 581 patients who underwent MV repair with annuloplasty ring replacement at our institution between 2010 and 2023. Among the 581 patients, 168 who underwent MV repair with the continuous wrapping suture technique were included in the main analysis. In the continuous wrapping suture technique, the ring was fixed at both the fibrous trigones of the anterior leaflet and was continuously sutured to wrap it circumferentially. The primary outcomes were perioperative procedure-related complications and ring dehiscence during the observation period.

Results: The median follow-up duration was 2.7 years. There were no annuloplasty-related complications, including left circumflex artery (LCX) injury and prosthetic ring dehiscence. The 1-year and 3-year postoperative recurrence rates of moderate or severe MR were 1.8% and 2.2%, respectively. Moreover, In the whole 581 patients who underwent mitral ring annuloplasty, multivariable analysis confirmed that the wrapping suture technique was significantly associated with a reduction in the 1-year postoperative mean MV pressure gradient (mean ratio 0.802; 95% confidence interval [CI], 0.728-0.884; P < 0.001).

Conclusions: The wrapping suture technique for robotic-assisted MV repair with ring annuloplasty is safe and effective, with no observed cases of LCX injury or ring dehiscence, and may serve as a reasonable alternative in anatomically challenging cases.