Minimally Invasive Mitral Valve Surgery: An Update

Hesham Alkady

doi:doi:10.11648/j.ijcts.20170305.11

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Minimally Invasive Mitral Valve Surgery: An Update

Hesham Alkady

Published in International Journal of Cardiovascular and Thoracic Surgery (Volume 3, Issue 5)

Received: 16 June 2017 Accepted: 27 September 2017 Published: 17 October 2017

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Abstract

Minimally invasive mitral valve surgery (MIMVS) was introduced in the mid-1990s to refer to a variety of surgical techniques that avoid full sternotomy through smaller or alternative chest wall incisions, as an attempt to reduce complications, but at the same time preserve outcomes of the full sternotomy approach. In this review, different aspects of MIMVS are discussed in relation to its approaches (right parasternal incision, lower ministernotomy, right anterolateral minithoracotomy and left posterior minithoracotomy) as well as strategies (mini-incisions, video-assistance, video direction with robotic assistance and telemanipulation) passing through more than 2 decades of continuous evolution. In the current practice MIMVS shows similar outcome to conventional surgery with even more superior results regarding blood loss, ICU and hospital stay, as well as functional recovery. The accumulating experience with MIMVS encouraged surgeons to extend the application of these techniques to high-risk patients, redo surgeries, concomitant double or triple valve procedures as well as combined coronary artery and mitral valve diseases in a hybrid approach, reducing the need for full median sternotomy. In addition there is an emerging trend of transcatheter valve implantation in the mitral position with small reports of valve-in valve or valve-in- ring implantation as well as valve replacement in case of severe MAC. This new trend may establish itself in the future as a modality in treating native mitral valve diseases in high risk patients. Therefore it is recommended for cardiac centers to build up a program for MIMVS in order to fulfill the recent requirements of cardiac surgery.

Published in	International Journal of Cardiovascular and Thoracic Surgery (Volume 3, Issue 5)
DOI	10.11648/j.ijcts.20170305.11
Page(s)	32-40
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2017. Published by Science Publishing Group

Keywords

Minimally Invasive Mitral Valve Surgery, Port Access, Totally Endoscopic Mitral Valve Surgery, Robotic Mitral Valve Surgery

References

[1]	Shuhaiber J, Anderson RJ. Meta-analysis of clinical outcomes following surgical mitral valve repair or replacement. Eur J CardiothoracSurg 2007; 31:267–75.
[2]	Gammie JS, Sheng S, Griffith BP, Peterson ED, Rankin JS, O’Brien SM et al. Trends in mitral valve surgery in the United States: results from the Society of Thoracic Surgeons adult cardiac database. Ann ThoracSurg 2009;87:1431–9.
[3]	Modi P, Hassan A, Chitwood WR Jr. Minimally invasive mitral valve surgery: a systematic review and meta-analysis. Eur J CardiothoracSurg 2008;34:943–52.
[4]	Gammie JS, Zhao Y, Peterson ED, O’Brien SM, Rankin JS, Griffith BP. J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg. 2010;90:1401-8. 10 e1; discussion 1408-10.
[5]	Santana O, Larrauri-Reyes M, Zamora C, Mihos CG. Is a minimally invasive approach for mitral valve surgery more cost-effective than median sternotomy? Interact CardioVasc Thorac Surg 2016;22:97–100.
[6]	Cheng DCH, Martin J, Lal A, Diegler A, Folliguet TA, Nifong LW et al. Minimally invasive versus conventional open mitral valve surgery. Innovation 2011;6:84–103.
[7]	McCLure RS, Athanasopoulus LV, McGurk S, Davidson MJ, Couper GS, Cohn LH. One thousand minimally invasive mitral valve operations: early outcomes, late outcomes, and echocardiographic follow-up. J Thorac Cardiovasc Surg 2013; 145:1199–206.
[8]	Moscarelli M, Cerillo A, Athanasiou T, Farneti P, Bianchi G, Margaryan R et al. Minimally invasive mitral valve surgery in high-risk patients: operating outside the boxplot. Interact CardioVascThoracSurg 2016;22:756–61.
[9]	Carpentier A, Loulmet D, Carpentier A, et al. Chirurgie a Coeur par video-chirurgieet mini-thoracotomie: premier cas (valvuloplastiemitrale) operesucces [first open heart operation (mitral valvuloplasty) under videosurgery through a minithoracotomy]. ComptesRendus De L’Academie des Sciences: Sciences de la Vie 1996;319:219-23.
[10]	Doty DB, Flores JH, Doty JR. Cardiac valve operations using a partial sternotomy (lower half) technique. J Card Surg 2000;15:35–42.
[11]	Navia JL, Cosgrove DM: Minimally invasive mitral valve operations. Ann ThoracSurg 1996;62: 1542-1544.
[12]	Cosgrove DM, Sabik JF, Navia JL. Minimally invasive valve operation. Ann ThoracSurg 1998;65:1535-9.
[13]	LishanAklog, David H. Adams, Gregory S. Couper, Reuben Gobezie, Samuel Sears, Lawrence H. Cohn. Techniques and results of direct-access minimally invasive mitral valve surgery: A paradigm for the future. The Journal of Thoracic and Cardiovascular Surgery.1998;116:705-715.
[14]	Doty D, DiRusso G, Doty J, et al. Full-spectrum cardiac surgery through a minimal incision: mini-sternotomy (lower half) technique. Ann Thorac Surg. 1998;65:56970.
[15]	James P. Greelish, Lawrence H. Cohn, MarziaLeacche, Michael Mitchell, Alexandros Karavas, John Fox, John G. Byrne, Sary F. Aranki, Gregory S. Couper. Minimally invasive mitral valve repair suggests earlier operations for mitral valve disease. J Thorac Cardiovasc Surg 2003;126:365-73.
[16]	Han-Song Sun, Wei-Guo Ma, Jian-Ping Xu, Li-Zhong Sun, Feng Lu, Xiao-Dong Zhu. Minimal Access Heart Surgery via Lower Ministernotomy: Experience in 460 Cases. Asian Cardiovasc Thorac Ann 2006; 14:109–13.
[17]	Murzi M, Cerillo AG, Miceli A, Bevilacqua S, Kallushi E, Farneti PA et al. Antegrade and retrograde arterial perfusion strategy in minimally invasive mitral valve surgery: a propensity score analysis on 1280 patients. Eur J Cardiothorac Surg 2013;43:e167–72.
[18]	Murzi M, Miceli A, Di Stefano G, et al. Mini- mally 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(6): 2763-2768.
[19]	Hesham Z. Saleh, HazaimAlwair and W. Randolph Chitwood Jr. Minimally invasive mitral valve surgery: still possible when aortic clamping is judged unsafe. Eur J Cardiothorac Surg 2013; 43 (6): 1274.
[20]	Joerg Seeburger, Michael Andrew Borger, Volkmar Falk and Friedrich Wilhelm Mohr. Gore-Tex Loop Implantation for Mitral Valve Prolapse: The Leipzig Loop Technique. Operative Techniques in Thoracic and Cardiovascular Surgery 2008;13(2):83-90.
[21]	Mihaljevic T, Cohn LH, Unic D, et al: One thousand minimally invasive valve operations: Early and late results. Ann Surg 2004; 240(3): 529-534.
[22]	Grossi EA, Galloway AC, Ribakove GH, et al: Impact of minimally invasive valvular heart surgery: A case-control study. Ann ThoracSurg 2001;71:807-810.
[23]	Modi P, Chitwood WR Jr. Retrograde femoral arterial perfusion and stroke risk during minimally invasive mitral valve surgery: is there cause for concern? Ann Cardiothorac Surg 2013;2:E1.
[24]	Crooke GA, Schwartz CF, Ribakove GH, Ursomanno P, Gogoladze G, Culliford AT et al. Retrograde arterial perfusion, not incision location, significantly increases the risk of stroke in reoperative mitral valve procedures. Ann ThoracSurg 2010;89:723–9; discussion 729–30.
[25]	Massimiano PS, Yanagawa B, Henry L, Holmes SD, Pritchard G, Ad N. Minimally invasive fibrillating heart surgery: a safe and effective approach for mitral valve and surgical ablation for atrial fibrillation. Ann ThoracSurg 2013;96:520–7.
[26]	Ad N, Holmes SD, Shuman DJ, Pritchard G, Massimiano PS. Minimally invasive mitral valve surgery without aortic cross-clamping and with femoral cannulation is not associated with increased risk of stroke compared with traditional mitral valve surgery: a propensity score-matched analysis. Eur J Cardiothorac Surg 2015;48:868–72.
[27]	Repossini A, Kotelnikov IN, Parenzan L, Arena V. Left-side approach to the mitral valve. J Heart Valve Dis. 2001;10:591-5.
[28]	Yoshikazu Suzuki, Francis D. Pagani, and Steven F. Bolling. Left Thoracotomy for Multiple-Time Redo Mitral Valve Surgery Using On-Pump Beating Heart Technique. Ann Thorac Surg. 2008;86:466 –71.
[29]	Pratt JW, Williams TE, Michler RE, Brown DA. Current indications for left thoracotomy in coronary revascularization and valvular procedures. Ann Thorac Surg. 2000;70:1366-70.
[30]	Saunders PC, Grossi EA, Sharony R, et al. Minimally invasive technology for mitral valve surgery via left thoracotomy: experience with forty cases. J Thorac Cardiovasc Surg 2004; 127:1026 –31.
[31]	Chitwood WR, Rodriguez E. Minimally invasive and robotic mitral valve surgery. In: Cohn LH (ed). Cardiac Surgery in the Adult, 4th edn. New York: McGraw-Hill, 2008, 1080–100.
[32]	Mohr FW, Falk V, Diegeler A, et al: Minimally invasive port-access mitral valve surgery. J Thorac Cardiovasc Surg 1998; 115(3):567-574.
[33]	Bradley S. Taylor and Hugo K. Vanermen. Totally Endoscopic Mitral Valve Repair. Operative Techniques in Thoracic and Cardiovascular Surgery.2007;12 (4):26-234.
[34]	Minoru Tabata, Nobuhiko Hiraiwa, Yuji Kawano, Daisuke Nakatsuka, and Satoshi Hoshino. A Simple, Effective, and Inexpensive Technique for Exposure of Papillary Muscles in Minimally Invasive Mitral Valve Repair: Wakka Technique. Ann ThoracSurg 2015;100:e59–61.
[35]	Mohr FW, Onnasch JF, Falk V, Walther T, Diegeler A, Krahor R, Schneider F, Autschbach R. The evolution of minimally invasive mitral valve surgery—2 year experience. Eur J Cardiothorac Surg 1999;15:233—9.
[36]	Reichenspurner H, Boehm DH, Gulbins H, Schulze G, Wildhirt S, Welz A, Detter C, Reichart B. Three-dimensional video and robot-assisted port access mitral valve operation. Ann Thorac Surg 2000;69:1176—82.
[37]	Felger JE, Nifong LW, Chitwood WRJr. The evolution and early experience with robot-assisted mitral valve surgery. Curr Surg. 2001;58:570-5.
[38]	Nifong LW, Chitwood WR, Pappas PS, et al: Robotic mitral valve surgery: a United States multicenter trial. J Thorac Cardiovasc Surg 2005;129:1395-1404.
[39]	Danny Ramzy, Alfredo Trento, Wen Cheng, Michele A. De Robertis, James Mirocha, Andrea Ruzza, and Robert M. Kass. Three hundred robotic-assisted mitral valve repairs: The Cedars-Sinai experience. Journal of Thoracic and Cardiovascular Surgery.2014;147 (1): 228-35.
[40]	Leland G. Siwek and Branden Reynolds. Totally Robotic Mitral Valve Repair. Operative Techniques in Thoracic and Cardiovascular Surgery.2007;12 (4):235-249.
[41]	Mihaljevic T, Koprivanac M, Kelava M, et al: Value of robotically assisted surgery for mitral valve disease. JAMA Surg 2014;149(7):679-686.
[42]	Seco M, Cao C, Modi P, Bannon PG, Wilson MK, Vallely MP et al. Systematic review of robotic minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2013;2:704–16.
[43]	Lars G. Svensson, Fernando A. Atik, Delos M. Cosgrove, Eugene H. Blackstone, Jeevanantham Rajeswaran, Gita Krishnaswamy, Ung Jin, A. Marc Gillinov, Brian Griffin, José L. Navia, Tomislav Mihaljevic, Bruce W. Lytle. Minimally invasive versus conventional mitral valve surgery: A propensity-matched comparison. Journal of Thoracic and Cardiovascular Surgery.2010 Apr; 139(4).
[44]	LamelasJ: Minimally invasive concomitant aortic and mitral valve surgery: “The Miami method”. Ann Cardiothorac Surg 2015; 4(1):33-37.
[45]	Santana O, Pineda AM, Cortes-Bergoderi M, et al: Hybrid approach of percutaneous coro- nary intervention followed by minimally inva- sive valve operations. Ann Thorac Surg 2014; 97(6): 2049-2055.
[46]	Prashanth Vallabhajosyula, Tyler Wallen, Aaron Pulsipher, Emil Pitkin, Lauren P. Solometo, Shenara Musthaq, Jeanne Fox, Michael Acker, and W. Clark Hargrove. Minimally Invasive Port Access Approach for Reoperations on the Mitral Valve. Ann Thorac Surg 2015;100:68–73.
[47]	Santana O, Reyna J, Grana R, et al: Outcomes of minimally invasive valve surgery versus stand- ard sternotomy in obese patients undergoing isolated valve surgery. Ann Thorac Surg 2011; 91(2): 406-410.
[48]	Santana O, Reyna J, Pineda AM, et al: Outcomes of minimally invasive mitral valve surgery in patients with an ejection fraction of 35% or less. Innovations (Phila) 2013; 8(1):1-5.
[49]	Lamelas J, Sarria A, Santana O, et al: Outcomes of minimally invasive valve surgery versus median sternotomy in patients age 75 years or greater. Ann Thorac Surg 2011;91(1):79-84.
[50]	Eidet J, Dahle G, Bugge JF, Bendz B, Rein KA, Aaberge L et al. Long-term outcomes after transcatheter aortic valve implantation: the impact of intraoperative tissue Doppler echocardiography. Interact Cardio Vasc Thorac Surg 2016; 23:403–9.
[51]	Wilbring M, Alexiou K, Tugtekin SM, Arzt S, Ibrahim K, Matschke K, et al. Pushing the limits—further evolutions of transcatheter valve procedures in the mitral position, including valve-in-valve, valve-in-ring, and valve-in-native-ring. JThorac Cardiovasc Surg 2014; 147:210-9.
[52]	Marek Polomsky, Konstantinos P. Koulogiannis, Robert M. Kipperman, Barry M. Cohen, Christopher J. Magovern, James P. Slater, Steve Xydas, Leo Marcoff, and John M. Brown. Mitral Valve Replacement WithSapien 3 Transcatheter Valve in Severe Mitral Annular Calcification. Ann ThoracSurg 2017;103:e57–9.
[53]	Renuka Jain, Mohamed F. Algahim, Tanvir K. Bajwa, Bijoy K. Khandheria, and Daniel P. O’Hair. Native Mitral Stenosis Treated With Transcatheter Mitral Valve Replacement. Ann Thorac Surg 2016;101:e75–7.
[54]	Lee R, Fukuhara S, George I, et al. Mitral valve replacement with a transcatheter valve in the setting of severe mitral annular calcification. J ThoracCardiovascSurg 2016;151:e47–9.
[55]	Murzi M, Cerillo AG, Bevilacqua S, et al. Enhancing departmental quality control in minimally invasive mitral valve surgery: a single-institution experience. Eur J Cardiothorac Surg 2012;42:500–6.
[56]	Michele Murzi, Antonio Miceli, Alfredo G. Cerillo, Gioia Di Stefano, Enkel Kallushi, Pierandrea Farneti, Marco Solinas, and Mattia Glauber. Training Surgeons in Minimally Invasive Mitral Valve Repair: A Single Institution Experience. Ann ThoracSurg 2014;98:884–9.
[57]	Stoica SC, Kalavrouziotis D, Martin BJ, et al. Long-term results of heart operations performed by surgeons-in-training. Circulation 2008; 30(14 Suppl).118:S1-6.

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Hesham Alkady. (2017). Minimally Invasive Mitral Valve Surgery: An Update. International Journal of Cardiovascular and Thoracic Surgery, 3(5), 32-40. https://doi.org/10.11648/j.ijcts.20170305.11

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Hesham Alkady. Minimally Invasive Mitral Valve Surgery: An Update. Int. J. Cardiovasc. Thorac. Surg. 2017, 3(5), 32-40. doi: 10.11648/j.ijcts.20170305.11

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Hesham Alkady. Minimally Invasive Mitral Valve Surgery: An Update. Int J Cardiovasc Thorac Surg. 2017;3(5):32-40. doi: 10.11648/j.ijcts.20170305.11

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@article{10.11648/j.ijcts.20170305.11,
  author = {Hesham Alkady},
  title = {Minimally Invasive Mitral Valve Surgery: An Update},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {3},
  number = {5},
  pages = {32-40},
  doi = {10.11648/j.ijcts.20170305.11},
  url = {https://doi.org/10.11648/j.ijcts.20170305.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20170305.11},
  abstract = {Minimally invasive mitral valve surgery (MIMVS) was introduced in the mid-1990s to refer to a variety of surgical techniques that avoid full sternotomy through smaller or alternative chest wall incisions, as an attempt to reduce complications, but at the same time preserve outcomes of the full sternotomy approach. In this review, different aspects of MIMVS are discussed in relation to its approaches (right parasternal incision, lower ministernotomy, right anterolateral minithoracotomy and left posterior minithoracotomy) as well as strategies (mini-incisions, video-assistance, video direction with robotic assistance and telemanipulation) passing through more than 2 decades of continuous evolution. In the current practice MIMVS shows similar outcome to conventional surgery with even more superior results regarding blood loss, ICU and hospital stay, as well as functional recovery. The accumulating experience with MIMVS encouraged surgeons to extend the application of these techniques to high-risk patients, redo surgeries, concomitant double or triple valve procedures as well as combined coronary artery and mitral valve diseases in a hybrid approach, reducing the need for full median sternotomy. In addition there is an emerging trend of transcatheter valve implantation in the mitral position with small reports of valve-in valve or valve-in- ring implantation as well as valve replacement in case of severe MAC. This new trend may establish itself in the future as a modality in treating native mitral valve diseases in high risk patients. Therefore it is recommended for cardiac centers to build up a program for MIMVS in order to fulfill the recent requirements of cardiac surgery.},
 year = {2017}
}

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TY  - JOUR
T1  - Minimally Invasive Mitral Valve Surgery: An Update
AU  - Hesham Alkady
Y1  - 2017/10/17
PY  - 2017
N1  - https://doi.org/10.11648/j.ijcts.20170305.11
DO  - 10.11648/j.ijcts.20170305.11
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 32
EP  - 40
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20170305.11
AB  - Minimally invasive mitral valve surgery (MIMVS) was introduced in the mid-1990s to refer to a variety of surgical techniques that avoid full sternotomy through smaller or alternative chest wall incisions, as an attempt to reduce complications, but at the same time preserve outcomes of the full sternotomy approach. In this review, different aspects of MIMVS are discussed in relation to its approaches (right parasternal incision, lower ministernotomy, right anterolateral minithoracotomy and left posterior minithoracotomy) as well as strategies (mini-incisions, video-assistance, video direction with robotic assistance and telemanipulation) passing through more than 2 decades of continuous evolution. In the current practice MIMVS shows similar outcome to conventional surgery with even more superior results regarding blood loss, ICU and hospital stay, as well as functional recovery. The accumulating experience with MIMVS encouraged surgeons to extend the application of these techniques to high-risk patients, redo surgeries, concomitant double or triple valve procedures as well as combined coronary artery and mitral valve diseases in a hybrid approach, reducing the need for full median sternotomy. In addition there is an emerging trend of transcatheter valve implantation in the mitral position with small reports of valve-in valve or valve-in- ring implantation as well as valve replacement in case of severe MAC. This new trend may establish itself in the future as a modality in treating native mitral valve diseases in high risk patients. Therefore it is recommended for cardiac centers to build up a program for MIMVS in order to fulfill the recent requirements of cardiac surgery.
VL  - 3
IS  - 5
ER  -

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Author Information

Hesham Alkady

Department of Cardiothoracic Surgery, Cairo University, Cairo, Egypt

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Plain Text BibTeX RIS

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Hesham Alkady. (2017). Minimally Invasive Mitral Valve Surgery: An Update. International Journal of Cardiovascular and Thoracic Surgery, 3(5), 32-40. https://doi.org/10.11648/j.ijcts.20170305.11

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ACS Style

Hesham Alkady. Minimally Invasive Mitral Valve Surgery: An Update. Int. J. Cardiovasc. Thorac. Surg. 2017, 3(5), 32-40. doi: 10.11648/j.ijcts.20170305.11

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Hesham Alkady. Minimally Invasive Mitral Valve Surgery: An Update. Int J Cardiovasc Thorac Surg. 2017;3(5):32-40. doi: 10.11648/j.ijcts.20170305.11

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@article{10.11648/j.ijcts.20170305.11,
  author = {Hesham Alkady},
  title = {Minimally Invasive Mitral Valve Surgery: An Update},
  journal = {International Journal of Cardiovascular and Thoracic Surgery},
  volume = {3},
  number = {5},
  pages = {32-40},
  doi = {10.11648/j.ijcts.20170305.11},
  url = {https://doi.org/10.11648/j.ijcts.20170305.11},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijcts.20170305.11},
  abstract = {Minimally invasive mitral valve surgery (MIMVS) was introduced in the mid-1990s to refer to a variety of surgical techniques that avoid full sternotomy through smaller or alternative chest wall incisions, as an attempt to reduce complications, but at the same time preserve outcomes of the full sternotomy approach. In this review, different aspects of MIMVS are discussed in relation to its approaches (right parasternal incision, lower ministernotomy, right anterolateral minithoracotomy and left posterior minithoracotomy) as well as strategies (mini-incisions, video-assistance, video direction with robotic assistance and telemanipulation) passing through more than 2 decades of continuous evolution. In the current practice MIMVS shows similar outcome to conventional surgery with even more superior results regarding blood loss, ICU and hospital stay, as well as functional recovery. The accumulating experience with MIMVS encouraged surgeons to extend the application of these techniques to high-risk patients, redo surgeries, concomitant double or triple valve procedures as well as combined coronary artery and mitral valve diseases in a hybrid approach, reducing the need for full median sternotomy. In addition there is an emerging trend of transcatheter valve implantation in the mitral position with small reports of valve-in valve or valve-in- ring implantation as well as valve replacement in case of severe MAC. This new trend may establish itself in the future as a modality in treating native mitral valve diseases in high risk patients. Therefore it is recommended for cardiac centers to build up a program for MIMVS in order to fulfill the recent requirements of cardiac surgery.},
 year = {2017}
}

Copy | Download

TY  - JOUR
T1  - Minimally Invasive Mitral Valve Surgery: An Update
AU  - Hesham Alkady
Y1  - 2017/10/17
PY  - 2017
N1  - https://doi.org/10.11648/j.ijcts.20170305.11
DO  - 10.11648/j.ijcts.20170305.11
T2  - International Journal of Cardiovascular and Thoracic Surgery
JF  - International Journal of Cardiovascular and Thoracic Surgery
JO  - International Journal of Cardiovascular and Thoracic Surgery
SP  - 32
EP  - 40
PB  - Science Publishing Group
SN  - 2575-4882
UR  - https://doi.org/10.11648/j.ijcts.20170305.11
AB  - Minimally invasive mitral valve surgery (MIMVS) was introduced in the mid-1990s to refer to a variety of surgical techniques that avoid full sternotomy through smaller or alternative chest wall incisions, as an attempt to reduce complications, but at the same time preserve outcomes of the full sternotomy approach. In this review, different aspects of MIMVS are discussed in relation to its approaches (right parasternal incision, lower ministernotomy, right anterolateral minithoracotomy and left posterior minithoracotomy) as well as strategies (mini-incisions, video-assistance, video direction with robotic assistance and telemanipulation) passing through more than 2 decades of continuous evolution. In the current practice MIMVS shows similar outcome to conventional surgery with even more superior results regarding blood loss, ICU and hospital stay, as well as functional recovery. The accumulating experience with MIMVS encouraged surgeons to extend the application of these techniques to high-risk patients, redo surgeries, concomitant double or triple valve procedures as well as combined coronary artery and mitral valve diseases in a hybrid approach, reducing the need for full median sternotomy. In addition there is an emerging trend of transcatheter valve implantation in the mitral position with small reports of valve-in valve or valve-in- ring implantation as well as valve replacement in case of severe MAC. This new trend may establish itself in the future as a modality in treating native mitral valve diseases in high risk patients. Therefore it is recommended for cardiac centers to build up a program for MIMVS in order to fulfill the recent requirements of cardiac surgery.
VL  - 3
IS  - 5
ER  -

Copy | Download