Significant reduction in annuloplasty operative time with the use of nitinol clips in robotically assisted mitral valve repair

ObjectiveA substantial barrier to widespread adoption of robotically assisted mitral valve repair surgery is increased operative time compared with that of median sternotomy. Nitinol U-clips (Medtronic, Minneapolis, Minn) made of a shape-memory alloy eliminate intrathoracic suturing and may reduce operative times.MethodsA retrospective review of robotically assisted mitral valve repair surgery was done at East Carolina University, where preoperative, intraoperative, and postoperative data were collected prospectively. The total time for U-clip or suture placement, as well as those for cardiopulmonary bypass, crossclamp, and annuloplasty band placement, were studied. Patients in whom only U-clips were used (“U-clips” cohort) were compared with those in whom only sutures were used (“sutures” cohort). Comparisons between groups were by two-tailed Student t test.ResultsBetween May 2000 and June 2004, U-clips were used exclusively in 50 patients (mean age 58.4 ± 13.2 years), and sutures were used exclusively in 72 patients (mean age 56.2 ± 12.9 years). The mean total time for placement and deployment of U-clips was shorter than for placement and tying of sutures (101 ± 45 seconds vs 186 ± 79 seconds, respectively, P < .001). Cardiopulmonary bypass, crossclamp, and annuloplasty band placement times were shorter in the U-clips cohort (144 ± 50 minutes vs 169 ± 35 minutes, 105 ± 30 minutes vs 132 ± 29 minutes, and 26 ± 5 minutes vs 40 ± 10 minutes, U-clips vs sutures, respectively, all P < .01).ConclusionsSignificantly shorter times were observed for placement and deployment of U-clips versus placement and tying of sutures, resulting in a reduction in mean band placement time of 14 minutes and significantly shorter cardiopulmonary bypass and crossclamp times in the U-clips cohort. Therefore, use of Nitinol U-clips instead of sutures may allow for significantly faster robotically assisted mitral valve repair surgery.