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 P 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.