Heart surgery will never be “no big deal,” but today more heart procedures are being performed using less invasive techniques. Among the latest innovations is robotic heart surgery, which is now being used at Yale for mitral valve repair and replacement.
Though catheter-based heart procedures (such as angioplasty to clear blocked veins) are now considered routine, structural heart disease (non-coronary heart disease) has been slower to benefit from these technological advances. In large part, this is because there is wide variance both in the extent of the heart disease and also in the size and shape of different peoples’ mitral valves.
In people with mitral valve regurgitation or mitral valve prolapse, when the heart pumps, the valves don’t close correctly. This allows blood to flow backwards into the heart, leaving some blood pooled in the left atrium. The heart has to work harder to pump the blood out, which can lead to heart failure.
Mitral valve repair and replacement have traditionally called for open heart surgery, but now—at Yale—robotic mitral valve repair and replacement is an option. “Yale is actually the only center in New England that does robotic mitral valve surgery,” says Arnar Geirsson, MD, section chief of cardiac surgery.
During surgery, the robot is being directed by the surgeon, and the whole surgery team is there assisting and working together, just like a normal operation. “The robot is just an extension and tool that the surgeon uses to do more complex operations,” Dr. Geirsson says.
In this video, you can see into the operating room as the robot’s four arms are controlled remotely by Dr. Geirsson, standing at a console, while the rest of the surgical team monitors the patient. Using the eyepiece, he sees a highly magnified, three-dimensional view of the surgery site, thanks to the cameras placed at the end of the robots’ arms. With fluid movements, he uses his hands to move joysticks and his feet to press pedals that translate into precise, steady movements from the robot as it makes incisions or stitches sutures.
“From my standpoint, there are two reasons why I like—and think it’s better—to do mitral valve surgery robotically,” says Dr. Geirsson. “First, the patients actually tend to do much better. It seems to be as safe as or even safer than a standard operation. Secondly, it’s really rewarding for patients,” he says. “They come in expecting a major open heart operation, but they really turn around so quickly and feel much better after the operation because it’s so much less invasive.”
[On August 18, 2020, the 100th robotic mitral valve repair surgery was performed at Yale New Haven Hospital by the robotic cardiac surgery team—a milestone for this procedure.]
Arnar Geirsson, MD, is chief of cardiac surgery for Yale Medicine, and a specialist in heart valve disease and thoracic aneurysm. Dr. Geirsson performs valve repairs on the mitral, tricuspid and aortic valves, as well as valve-sparing root operations.