Minimally invasive valve surgery

Abstract

Cardiac valve surgery is life saving for many patients. The advent of minimally invasive surgical techniques has historically allowed for improvement in both postoperative convalescence and important clinical outcomes. The development of minimally invasive cardiac valve repair and replacement surgery over the past decade is poised to revolutionize the care of cardiac valve patients. Here, we present a review of the history and current trends in minimally invasive aortic and mitral valve repair and replacement, including the development of sutureless bioprosthetic valves.

Figure 1

Incisions for minimally invasive aortic valve replacement. J-hemisternotomy (A), L-hemisternotomy (B), inverted-T partial sternotomy (C), right anterior thoracotomy (D).

Figure 2

Mini-AVR through a J-hemisternotomy revealing the exposed ascending aorta (A, arrow).Following cross-clamp placement, an aortotomy is made and the native valve is explanted (B). Skin closure following completion of the procedure (C). Ruler on the marking pen denotes 4 cm.

Figure 3

Right 3^rd intercostal anterior mini-thoracotomy for “port-access” mitral valve repair. View through the mini-thoracotomy (A) is greatly augmented by a laterally placed thoracoscope. Sutures are placed circumferentially (B) to secure a semi-rigid annuloplasty ring (C). Incision is seen 6 weeks postoperatively (arrow, D).

Figure 4

Traditional sutured prosthetic aortic valve placement through a minimally invasive J-hemisternotomy (A). Percival S self-expanding aortic tissue valve with Sinus of Valsalva struts (B, from www.sorin.com/product/perceval-s). Perceval S valve placed in the aortic position (C, arrow).