Minimally Invasive Mitral Valve Surgery via Mini-Thoracotomy: Current Update
- 274 Downloads
In recent years, minimally invasive mitral valve surgery (MIMVS) has established itself as an alternative and increasingly used option for patients with mitral valve (MV) pathology. MIMVS is associated with a very low perioperative morbidity and mortality rate in appropriately selected patients, comparable to a full sternotomy approach. Besides superior cosmetic results, patients after MIMVS enjoy shorter recovery times and earlier returns to full activity. A number of approaches are branded as minimally invasive, but the most widely used one entails peripheral cardiopulmonary bypass and a small right anterolateral mini-thoracotomy. The operative technique and outcomes of this approach are summarized in the current update.
KeywordsMinimally invasive Mitral valve repair Mini-thoracotomy Endoscopic
Compliance with Ethics Guidelines
Conflict of Interest
Serguei I. Melnitchouk, Jacob P. Dal-Bianco, and Michael A. Borger each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 5.Goldstone AB, Atluri P, Szeto WY, Trubelja A, Howard JL, MacArthur Jr JW, et al. Minimally invasive approach provides at least equivalent results for surgical correction of mitral regurgitation: a propensity-matched comparison. J Thorac Cardiovasc Surg. 2013;145:748–56.PubMedCentralCrossRefPubMedGoogle Scholar
- 10.•Petracek MR, Leacche M, Solenkova N, Umakanthan R, Ahmad RM, Ball SK, et al. Minimally invasive mitral valve surgery expands the surgical options for high-risks patients. Ann Surg. 2011;254:606–11. This paper describes minimally invasive mitral valve surgery approach by use of fibrillatory arrest in order to avoid aortic cross-clamping and cardioplegic myocardial arrest in patients with prior sternotomy. Authors report low mortality and morbidity on 504 consecutive patients who underwent mitral valve surgery via this approach. They conclude that this approach expands the surgical options for high-risk patients and yields to superior results than the conventional median sternotomy approach.CrossRefPubMedGoogle Scholar
- 24.Suri RM, Burkhart HM, Daly RC, Dearani JA, Park SJ, Sundt 3rd TM, et al. Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: establishing the benchmark against which percutaneous interventions should be judged. J Thorac Cardiovasc Surg. 2011;142:970–9.CrossRefPubMedGoogle Scholar
- 26.Maisano F, Schreuder JJ, Oppizzi M, Fiorani B, Fino C, Alfieri O. The double-orifice technique as a standardized approach to treat mitral regurgitation due to severe myxomatous disease: surgical technique. Eur J Cardiothorac Surg : Off J Eur Assoc Cardiothorac Surg. 2000;17:201–5.CrossRefGoogle Scholar
- 32.•Davierwala PM, Seeburger J, Pfannmueller B, Garbade J, Misfeld M, Borger MA, et al. Minimally invasive mitral valve surgery: “The Leipzig experience”. Ann Cardiothorac Surg. 2013;2:744–50. This is a report on a total of 3438 patients who underwent minimally invasive mitral valve surgery at the Leipzig Heart Center where it became a routine procedure. Authors report excellent results of the procedure that can be performed safely and effectively with very few perioperative complications.PubMedCentralPubMedGoogle Scholar
- 38.Murzi M, Miceli A, Di Stefano G, Cerillo AG, Farneti P, Solinas M, et al. Minimally invasive right thoracotomy approach for mitral valve surgery in patients with previous sternotomy: a single institution experience with 173 patients. J Thorac Cardiovasc Surg. 2014;148:2763–8.CrossRefPubMedGoogle Scholar
- 39.•Arcidi Jr JM, Rodriguez E, Elbeery JR, Nifong LW, Efird JT, Chitwood Jr WR. Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve. J Thorac Cardiovasc Surg. 2012;143:1062–8. This systematic review and meta-analysis of comparative studies was performed to update the current evidence on mitral valve surgery through a lateral mini-thoracotomy versus median sternotomy. More than 20,000 patients from 45 studies were included in this study, allowing the authors to conclude that MIMVS and conventional mitral valve surgery have a similar perioperative outcome. Mitral valve surgery via a right lateral mini-thoracotomy seems to be favorable with regard to resource-related outcome.CrossRefPubMedGoogle Scholar