Strategic implementation of a new robotic mitral repair program: Early experience and outcomes.

Abstract

Despite numerous reported benefits of robotic mitral repair, the absolute number of procedures performed remain low in part to uncertainties about the necessary steps to launch a program. In this report, we describe our early outcomes and strategy with launching a successful new robotic mitral repair program. Our multimodal strategic plan emphasized team education, hands-on technical preparation, stepwise advancement, and careful patient selection. Consultant service analytics and team debriefings allowed for iterative improvements. Between March 2022 and February 2024, 50 patients underwent robotic mitral repair at our institution. Average age at time of operation was 62 years with a Society of Thoracic Surgeons risk score of 0.58. Successful repairs were performed in 98% of patients. There was 1 conversion to sternotomy. There were no deaths, and there was minimal perioperative morbidity. On both predischarge and follow-up echocardiography, no patients had greater than mild mitral regurgitation. Our work provides a model for establishing a successful robotic mitral program. An up-front emphasis on team education, careful preparation, proper patient selection, and feedback-driven improvements can accelerate the attainment of standards set by high-volume centers.