da Vinciによる僧帽弁形成術の初期成績

Early Clinical Outcomes of Robotic Mitral Valve Repair；Initial Twenty Cases

2018年4月に胸腔鏡補助下弁形成術，胸腔鏡補助下弁置換術が保険収載されたことによって，ロボット支援下の心臓手術を保険下に施行することができるようになった．本邦ではロボット心臓手術関連学会協議会が心臓外科におけるda Vinci支援下手術のための指針を出し，施設基準［心停止下低侵襲心臓手術（MICS）20例以上など］，術者およびda Vinci手術チーム基準を設け，安全性を担保したロボット手術の普及を図っている．当院では以前より，MICSに積極的に取り組んできたが，このたび2018年12月よりロボット支援下手術を導入して僧帽弁形成術を開始したのでその初期成績を報告する．

We report the early results of our initial 20 consecutive robotic-assisted mitral valve repairs at our institution. A total of 20 patients （aged 55±10 years, 15 males） underwent robotic assisted mitral repairs by using da Vinci system. Successful mitral valve repairs were done in all cases. All patients received an annuloplasty band. Triangular resection were done in 2 cases and artificial chordae were used in 18 cases. There was no conversion to sternotomy intraoperatively. Three cases needed recross-clamping because of mitral regurgitation, mitral stenosis and the problem of venous canula. Cardiopulmonary bypass time and aortic cross-clamp time were 272±56 minutes, 153±41 minutes. There were no hospital mortality and major complications. Post-pump echocardiograms showed no/trivial mitral regurgitation in all cases. Robotic-assisted mitral valve repairs were done safely and the early results were acceptable in our series.