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. 2016 Jul-Aug;11(4):251-9.
doi: 10.1097/IMI.0000000000000300.

Minimally Invasive Mitral Valve Surgery II: Surgical Technique and Postoperative Management

J Alan Wolfe  1 , S Chris Malaisrie, R Saeid Farivar, Junaid H Khan, W Clark Hargrove, Michael G Moront, William H Ryan, Gorav Ailawadi, Arvind K Agnihotri, Brian W Hummel, Trevor M Fayers, Eugene A Grossi, T Sloane Guy, Eric J Lehr, John R Mehall, Douglas A Murphy, Evelio Rodriguez, Arash Salemi, Romualdo J Segurola Jr, Richard J Shemin, J Michael Smith, Robert L Smith, Paul W Weldner, Clifton T P Lewis, Glenn R Barnhart, Scott M Goldman
Affiliations

Minimally Invasive Mitral Valve Surgery II: Surgical Technique and Postoperative Management

J Alan Wolfe et al. Innovations (Phila). 2016 Jul-Aug.

Abstract

Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery.

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Figures

FIGURE 1
FIGURE 1
Lower hemisternotomy incision.
FIGURE 2
FIGURE 2
Lower hemisternotomy showing placement of retractor and cannulae.
FIGURE 3
FIGURE 3
Patient positioning for direct-vision right minithoracotomy, showing a small pillow placed inferior to the scapula (transparent ellipse). The vertical dashed line indicates the placement of the primary incision.
FIGURE 4
FIGURE 4
Exteriorization of sutures for diaphragmatic retraction.
FIGURE 5
FIGURE 5
Incisions for working port and retractor. The red dot represents the location of the incision for the retractor.
FIGURE 6
FIGURE 6
Retraction of the interatrial septum.
FIGURE 7
FIGURE 7
Endoscopic visualization of the MV.
FIGURE 8
FIGURE 8
Endoaortic occlusion balloon positioning. A, Correct balloon position. B, Proximal migration may allow leakage around the balloon and possible iatrogenic puncture. C, Distal migration may diminish brachiocephalic perfusion. Note the tip of the venous cannula 2 to 3 cm above the junction of the right atrium and superior vena cava.
See this image and copyright information in PMC

References

    1. Cohn LH, Adams DH, Couper GS, et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg. 1997;226:421–426. - PMC - PubMed
    1. Ailawadi G, Agnihotri AK, Mehall JR, et al. Minimally invasive mitral valve surgery I: patient selection, evaluation, and planning. Innovations. 2016;11:243–250. - PMC - PubMed
    1. Lehr EJ, Guy TS, Smith RL, et al. Minimally invasive mitral valve surgery III: training and robotic-assisted approaches. Innovations. 2016;11:260–267. - PMC - PubMed
    1. Youssef SJ, Millan JA, Youssef GM, Earnheart A, Lehr EJ, Barnhart GR. The role of computed tomography angiography in patients undergoing evaluation for minimally invasive cardiac surgery: an early program experience. Innovations. 2015;10:33–38. - PubMed
    1. Rodriguez R, Gojkovic O, Khitri A, et al. Totally endoscopic minimally invasive mitral valve surgery as a routine approach: a 10 year experience. Mitral Conclave American Association for Thoracic Surgery, Sheraton Towers, New York, NY USA, May 5–6, 2011.

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