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

Objective: A 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.

Methods: A 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.

Results: Between 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).

Conclusions: Significantly 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.