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. 2023 Oct 4;37(4):ivad154.
doi: 10.1093/icvts/ivad154.

An international survey-based assessment of minimally invasive mitral valve surgery

Ali Fatehi Hassanabad  1 , Umar Imran Hamid  2   3 , Peyman Sardari Nia  2
Affiliations

An international survey-based assessment of minimally invasive mitral valve surgery

Ali Fatehi Hassanabad et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: Minimally invasive mitral valve surgery (MIMVS) has been shown to be safe and feasible however its adoption has lagged globally. The international consortium is lacking a set of guidelines that are specific to MIMVS. The aim of this study was to capture the practices of MIMVS in different centres.

Methods: A survey was constructed containing 52 multiple-choice and open-ended questions about various aspects of MIMVS. The survey was sent to centres that routinely and frequently perform MIMVS. All surgeons provided informed consent for participating in the survey and publication of data.

Results: The survey was sent to 75 known surgeons from whom 32 (42%) completed the survey. All survey responders performed >25 MIMVS cases annually. Twenty (68%) of the surgeons thought that simulation training, MIMVS fellowship and proctorship are all essential prior to commencing an MIMVS program. Eleven (34%) of the surgeons stated that 50-100 MIMVS cases are required to overcome the learning curve, followed by 6 (18%) who said 21-30 cases should suffice. Eighteen (62%) of the surgeons had adopted a fully endoscopic approach for their MIMVS, followed by 15 (51%) surgeons who had performed cases via endoscopic-assisted strategies, 5 (17%) surgeons had conducted the operation under direct visualization and 6 (20%) surgeons had used a robot for their MIMVS.

Conclusions: The study highlights a marked variability on training and approach to MIMVS. Consensus guidelines should be established to allow standardization of MIMVS.

Keywords: International survey; Minimally invasive cardiac surgery; Minimally invasive mitral valve surgery.

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Figures

Figure 1:
Figure 1:
Demographics of survey responders. (A) Survey responders’ type of practice. (B) Age group of survey responders. (C) Number of years of practice of survey responders. (D) Number of minimally invasive mitral valve surgery cases performed by the survey responders annually.
Figure 2:
Figure 2:
Training and learning curve for MIMVS. (A) Type of training required as per survey responders prior to performing MIMVS. (B) The learning curve of MIMVS training as per survey responders. MIMVS: minimally invasive mitral valve surgery.
Figure 3:
Figure 3:
Survey responders’ approach to a porcelain aorta where applying an aortic cross-clamp is not safe or possible.
Figure 4:
Figure 4:
Surgical approach for MIMVS. (A) Intraoperative valvular visualization and assessment for MIMVS cases. (B) Cannulation strategy for MIMVS. MIMVS: minimally invasive mitral valve surgery.
Figure 5:
Figure 5:
Mitral valve pathologies and repair strategies for MIMVS. (A) Valve pathologies amenable to MIMVS. (B) Repair strategies for MIMVS. MIMVS: minimally invasive mitral valve surgery.
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