Minimally invasive mitral valve surgery via right minithoracotomy

Abstract

From early experience in cardiac surgery on the mitral valve, access was gained in different ways: through left and right antero-lateral extended thoracotomy for closed and correspondingly for open mitral commissurotomy, from right parasternal access with rib resection, and via median sternotomy. Median sternotomy remains the most common approach for mitral valve procedures, such as replacement or repair, allowing good visualisation, exposure and working field. Applying the largely spread access as median sternotomy, surgeons always wanted to overcome the necessity of large incisions, get a better surgical view, to dissect with better respect to structural integrity and have better aesthetic results. Enhanced understanding of surgical bases and technological development sourced a breakthrough in minimally-invasive approach for mitral valve surgery, offering several advantages such as less postoperative pain, lower morbidity and mortality, faster recovery and shorter hospital stay. In an effort to share the institutional experience in less invasive surgery, this article demonstrates our approach in mitral valve repair through a right minithoracotomy in the 3rd or 4th intercostal space.

Minimally Invasive Septal Myectomy for the Treatment of Hypertrophic Obstructive Cardiomyopathy and Intrinsic Mitral Valve Disease

“…Femorofemoral perfusion and endoaortic balloon clamping have been abandoned in our center with the introduction of direct aortic cannulation and direct external transthoracic clamping, 35 as shown by Figures 1 and 2, resulting in a lower rate of neurological and vascular complications after minimally invasive mitral valve surgery.…”

Surgical resection of colorectal carcinomas metastatic to the heart

“…The rest of the operation was carried out using direct aortic cross clamping with a Cygnet clamp (Novare, Cupertino, CA, USA), warm blood cardioplegia, and encircling the SVC and inferior vena cava. 23 At gross examination the mass was yellowish, of elastic consistency, and focal areas of hemorrhage and necrosis were present ( Figure 2C and D). The mass was involving only a limited portion of the septum and was, therefore, excised using blunt dissection; as the interatrial septum was of normal appearance, only curettage of the tumor stalk was performed.…”

“…A separate 15‐Fr cannula (Medtronic) for the superior vena cava (SVC) drainage was used. The rest of the operation was carried out using direct aortic cross clamping with a Cygnet clamp (Novare, Cupertino, CA, USA), warm blood cardioplegia, and encircling the SVC and inferior vena cava . At gross examination the mass was yellowish, of elastic consistency, and focal areas of hemorrhage and necrosis were present (Figure C and D).…”

Minimally invasive mitral valve surgery in high-risk patients: operating outside the boxplot

“…Our surgical approach has been previously described before [4,5]. Briefly, a catheter sheath is placed in the right femoral vein.…”