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Review
. 2021 Mar;13(3):1960-1970.
doi: 10.21037/jtd-20-2114.

Minimally invasive mitral valve surgery

Yasir Abu-Omar  1 , Ibrahim T Fazmin  2 , Jason M Ali  2 , Marc P Pelletier  1
Affiliations
Review

Minimally invasive mitral valve surgery

Yasir Abu-Omar et al. J Thorac Dis. 2021 Mar.

Abstract

There is considerable interest and demand in the application of minimally invasive techniques in cardiac surgery driven by multiple factors including patient cosmesis and satisfaction, reduction of surgical trauma and the development of specialized instrumentation that allows these procedures to be performed safely. Minimally invasive mitral valve surgery (MIMVS) has been conducted for more than 25 years and has been shown to offer multiple benefits including better cosmetic results, enhanced post-operative recovery, improved patient satisfaction and most importantly, equivalent clinical outcomes with regards to quality and safety when compared to the standard sternotomy approach. MIMVS may be particularly beneficial in certain subgroups of patients, for example patients undergoing redo mitral valve surgery. In this article, we discuss patient selection criteria for MIMVS, the merits and drawbacks of MIMVS relative to conventional sternotomy approaches, and detail procedural aspects including anaesthetic management, intraoperative technique, and important considerations in myocardial protection and cardiopulmonary bypass (CPB). When considering developing a MIMVS programme, as for any new technique, a team approach to the introduction of the programme is essential. Although it is clear that patient selection is important, particularly early in a surgical programme, with experience complex repairs can be performed through a minimally invasive approach with excellent outcomes.

Keywords: Mini-thoracotomy; mini-mitral surgery; minimally invasive surgery.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-2114). The series “Minimally Invasive Cardiac Surgery” was commissioned by the editorial office without any funding or sponsorship. Jason Ali and Yasir Abu-Omar served as the unpaid Guest Editors of the series. Jason Ali serves as an unpaid editorial board member of Journal of Thoracic Disease from Oct 2019 to Sep 2021. The authors have no other conflicts of interest to declare.

Figures

Figure 1
Figure 1
Demonstration of the anatomical landmarks and position of incisions and ports for minimally invasive mitral valve surgery.
Figure 2
Figure 2
Demonstration of the set-up for minimally invasive mitral valve surgery, with utility port.
Figure 3
Figure 3
View of the mitral valve during minimally invasive mitral valve surgery following repair.
Figure 4
Figure 4
Example of the cosmetic result following minimally invasive mitral valve surgery.
See this image and copyright information in PMC

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