Minimally Invasive Mitral Valve Surgery

Conventional heart surgery incision (median sternotomy).

The incision is larger (about 6 - 8 inches), made down the sternum, through bone and muscle.

Minimally invasive incision (right mini-thoracotomy)

The right mini-thoracotomy is performed with a 2-inch skin incision created in a skin fold on the right chest, providing an excellent cosmetic result.

The heart is approached between the ribs, providing the surgeon access to the mitral valve. There is no sternal incision or spreading of the ribs required for this surgical technique.The surgeon inserts special surgical instruments through the incision to perform the valve repair. Results with this approach are excellent.

Conventional versus minimally invasive mitral surgery

The choice of a conventional versus minimally invasive approach for a patient undergoing mitral valve surgery depends on patient factors as well as surgeon and institutional factors.

Surgeon and institutional factors — Expert and experienced surgical, anesthesia, nursing, and perfusion teams are required to optimize the benefits and minimize the risks of surgery through smaller incisions. This is especially true for mitral valve surgery since the likelihood of successful repair (versus replacement) varies significantly with both individual surgeon and institutional volumes [1].

Patient selection and evaluation — A detailed patient assessment is required prior to mitral surgery to assess potential risks and benefits of available approaches and choose the optimum surgical approach. Although minimally invasive mitral valve surgery procedures are becoming more standardized and common, patients are still highly screened and selected.

The following are typical exclusions (some experienced surgical teams may perform MIMS in selected patients with one or more of these characteristics):

●Need for concomitant coronary revascularization (although isolated non-left main/left anterior descending coronary artery disease can be treated with percutaneous coronary intervention).

●Need for concomitant aortic valve intervention.

●Complex mitral valve pathology (evere annular calcification).

●Obesity, funnel chest or adverse body habitus limiting access or visibility.

●Previous right thoracotomy, radiation, pulmonary hypertension, or severe chronic obstructive pulmonary disease.