Combined minimally invasive repair of pectus excavatum and robotically assisted mitral valve repair: A case report and considerations

摘要

INTRODUCTION: Severe pectus excavatum (PE) is considered a relative contraindication to robotic cardiac surgery and information is lacking on surgical solutions to allow for a robotic approach in this setting. OBJECTIVE: We present a case of concomitant minimally invasive treatment of severe PE with initial pectus correction with Nuss bar insertion followed by robotically assisted mitral valve repair. METHODS: A multidisciplinary team planned and executed the operation. Thoracoscopic assessment at the onset of the case demonstrated mediastinal exposure was inadequate for robotic repar without PE correction. Forced sternal elevation demonstrated sternal laxity sufficient to provide adequate exposure. Nuss bars were placed and robotic repair proceeded uneventfully. RESULTS: The patient underwent successful concomitant minimally invasive PE and robotically assisted mitral repair. CONCLUSION: Successful combined minimally invasive pectus repair and robotic mitral valve can be achieved if sufficient chest wall laxity is present on forced sternal elevation and access sites are planned properly in a multidisciplinary approach.