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Minimally Invasive Mitral Valve Surgery via Right Minithoracotomy

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Minimally Invasive Thoracic and Cardiac Surgery

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Abstract

Mitral valve (MV) disease is the most prevalent form of heart valve disease with an age-related increase in incidence. Surgical valve repair or replacement is the only treatment for mitral regurgitation with defined clinical success. The conventional surgical correction of significant valvular regurgitation usually consists of repair or replacement of the MV through a median full-length sternotomy, which remains the “classic” approach for the majority of procedures involving the MV.

From early experience in MV surgery, several types of surgical access were established: through left and right anterolateral thoracotomy for closed and correspondingly for open mitral commissurotomy, from right parasternal access with rib resection, and through a full median sternotomy. These methods have been studied and evaluated by cardiac surgeons through the years to establish known benefits and drawbacks. Factors influencing the choice of access have included improved working field exposure, visualization, ergonomics and cosmetic outcomes, and superior preservation of the structural and morphological integrity of tissues.

Applying technological development to successful basic cardiac surgical techniques has led to the introduction of minimally invasive approaches to cardiac valve procedures. Today, as an alternative to conventional surgical approaches, the minimally invasive surgical technique in the treatment of heart valve diseases has become a rapidly evolving field offering several advantages including reduced postoperative pain, decreased morbidity and mortality, faster recovery, shorter hospital stays, reduced costs, and improved cosmetic appearance at the incision site. Currently, the most innovative minimally invasive techniques include port-access valve surgery, achieved through a small minithoracotomy and performed as either direct-vision, video-assisted, or robotically assisted valve surgery through the right minithoracotomy.

In our institution, port-access surgery concepts and technique was initially introduced for minimally invasive repair and replacement in isolated MV diseases. Today, we perform the majority of our isolated mitral procedures and also concomitant tricuspid and/or aortic valve surgeries through the minithoracotomy using direct and/or video-assisted approach. In this chapter, we will focus on the minimally invasive surgical techniques used in surgery today for performing MV surgery through a right minithoracotomy.

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Authors and Affiliations

  1. Department of Cardiothoracic Surgery, Heart Hospital, “G. Monasterio” Tuscany Foundation for Research and Health, Via Aurelia Sud, 54100, Massa, Italy

    Jamshid H. Karimov M.D., Ph.D. & Mattia Glauber M.D.

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  1. Jamshid H. Karimov M.D., Ph.D.
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  2. Mattia Glauber M.D.
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Correspondence to Jamshid H. Karimov M.D., Ph.D. .

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Editors and Affiliations

  1. Klinik Hirslanden, Thoraxzentrum Zürich, Witellikerstr. 40, Zürich, 8008, Switzerland

    Rolf Gilbert Carl Inderbitzi

  2. , Division of General Thoracic Surgery, University Hospital Berne
, Freiburgstr. 2010, Berne, 3010, Switzerland

    Ralph Alexander Schmid

  3. , Department of Cardio-Thoracic Surgery, University of Pisa, Via Paradisa 2, Pisa, 56100, Italy

    Franca M. A. Melfi

  4. St. Mary's Hospital, Department of Cardio-Thoracic Surgery, Imperial College Healthcare NHS Trust, Praed Street, LONDON, W2 1NY, United Kingdom

    Roberto Pasquale Casula

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Karimov, J.H., Glauber, M. (2012). Minimally Invasive Mitral Valve Surgery via Right Minithoracotomy. In: Inderbitzi, R., Schmid, R., Melfi, F., Casula, R. (eds) Minimally Invasive Thoracic and Cardiac Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-11861-6_40

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  • DOI: https://doi.org/10.1007/978-3-642-11861-6_40

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