Key result
Robotic right thoracotomy repairs complex AV groove pseudoaneurysm and prosthetic dehiscence after prior mitral replacements.
Case Report (n=1)
Robot-assisted minimally invasive techniques can be successfully utilized for complex redo mitral valve replacement and pseudoaneurysm repair even in heavily scarred surgical fields.
May support robotic repair in select complex redo mitral cases; hypothesis-generating and should not change practice.
We report the use of robot-assisted right thoracotomy in the management of a patient who presented with acute-on-chronic congestive heart failure, associated with a contained atrioventricular dissection and 2 prior mitral valve replacements. Our patient had evidence of a contained rupture, as represented by preoperative cross-sectional imaging. The anatomic sequela from this was a ventricular pseudoaneurysm, which was likely survivable due to adhesions from prior operations buttressing the margins of the defect. Expansion of the pseudoaneurysm likely contributed to the dehiscence of the prosthesis. Our case illustrates an unprecedented resolution of a serious complication, managed effectively and efficiently by a robot-assisted procedure. With a successful outcome of totally endoscopic and robot-assisted repair, we demonstrate the versatility of minimally invasive techniques in addressing complicated anatomy as well as a surgical field scarred by multiple prior surgeries.
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DeLay et al. (2022) conducted a case report in Acute-on-chronic congestive heart failure with contained atrioventricular dissection and ventricular pseudoaneurysm (n=1). Robot-assisted right thoracotomy was evaluated. Robot-assisted right thoracotomy successfully managed a complex atrioventricular groove pseudoaneurysm and prosthetic dehiscence in a patient with two prior mitral valve replacements.
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