Minimally Invasive Mitral Valve Procedures: The Current State

Abstract

Since its early days, cardiac surgery has typically involved large incisions with complete access to the heart and the great vessels. After the popularization of the minimally invasive techniques in general surgery, cardiac surgeons began to experiment with minimal access techniques in the early 1990s. Although the goals of minimally invasive cardiac surgery (MICS) are fairly well established as decreased pain, shorter hospital stay, accelerated recuperation, improved cosmesis, and cost effectiveness, a strict definition of minimally invasive cardiac surgery has been more elusive. Minimally invasive cardiac surgery started with mitral valve procedures and then gradually expanded towards other valve procedures, coronary artery bypass grafting, and various types of simple congenital heart procedures. In this paper, the authors attempt to focus on the evolution, techniques, results, and the future perspective of minimally invasive mitral valve surgery (MIMVS).

Minimally invasive mitral valve surgery is associated with a low rate of complications

“…Prospective data collection was approved by the regional Human Research Ethics Committee, Stockholm, Sweden. The patient selection, reflected in the preoperative characteristics of patients, is comparable to other studies . Mean age was 62.9 years, and 21.6% were female.…”

“…There is no evidence suggesting a significant difference in mortality between MIMVS and full‐sternotomy mitral valve surgery. Early mortality has been reported to be similar between the two groups and does not differ between observational and prospective data . In a study comparing 474 MIMVS patients to 337 full‐sternotomy mitral valve surgery patients, perioperative mortality was very low in both groups (0.2–0.3%) .…”

“…Several studies indicate MIMVS to be a safe procedure with excellent short‐ and long‐term outcomes . In several high‐volume centres, MIMVS has therefore become the standard surgical approach for the treatment of mitral valve disease.…”

“…Critics are concerned that MIMVS is technically more demanding with decreased surgical exposure, possibly affecting the repair rate and quality of mitral valve repair . However, several studies have shown MIMVS to have excellent efficacy of valve repair with repair rates and long‐term durability equal to those of full‐sternotomy mitral valve surgery . Mitral valve reoperation rates have been reported to be very low after MIMVS .…”

“…The length of stay in the intensive care unit and total in-hospital stay have been shown to be significantly reduced in MIMVS compared to fullsternotomy group [1][2][3]5]. This has initiated a debate regarding cost efficiency of MIMVS as costs are mainly driven by hospital stay.…”