Robot -Assisted Mitral Valve Repair via Right Mini-Thoracotomy in a Patient with a History of Cardiac Surgery via Median Sternotomy: A Case Report and Technical Considerations

Abstract Background: Reoperative mitral valve surgery after prior median sternotomy is challenging because of retrosternal adhesions and the risk of cardiac injury during resternotomy. Case Presentation: A 75-year-old woman with a history of atrial septal defect closure via median sternotomy 30 years earlier presented with congestive heart failure. Echocardiography showed moderate mitral regurgitation and severe tricuspid regurgitation caused by annular dilatation. Computed tomographic angiography confirmed the feasibility of a right thoracic approach and peripheral cannulation. Robot-assisted mitral and tricuspid valve repair was performed using the da Vinci Xi system. Following limited adhesiolysis, the ascending aorta was cross-clamped and antegrade cardioplegia administered. Mitral and tricuspid annuloplasty were completed successfully without major complications.