Minimally Invasive Mitral Valve Surgery II Surgical Technique and Postoperative Management

Abstract

Techniques for minimally invasive mitral valve repair and replacement continue to evolve. This expert opinion, the second of a 3-part series, outlines current best practices for nonrobotic, minimally invasive mitral valve procedures, and for postoperative care after minimally invasive mitral valve surgery.

Minimally Invasive Mitral Valve Surgery I: Patient Selection, Evaluation, and Planning

“…If comparison to the contralateral leg shows a significant difference, a small cannula should be placed in the distal superficial femoral artery to avoid leg ischemia. 17…”

Minimally Invasive Mitral Valve Surgery III: Training and Robotic-Assisted Approaches

“…As with port-access mitral surgery, a transthoracic aortic cross-clamp or an endoaortic occlusion balloon can be used to isolate the coronary circulation from the systemic blood flow. 14 When using a transthoracic cross-clamp in robotic-assisted cases, it should be inserted through a lateral stab wound in the second intercostal space, 8 to 10 cm posterior to the left robotic arm to avoid internal and external conflict with the robotic arms. The access site for the cardioplegia catheter is controlled with a purse-string suture and can be placed directly through the incision with long instruments, or robotically.…”

“…Limitations of endoaortic balloon occlusion are distal balloon migration and obstruction of the arch vessels, impaired exposure of the left fibrous trigone with proximal migration on the balloon, and increased complexity of cannulation. Please refer to Wolfe et al 14 for a more extensive discussion of approaches to aortic occlusion in MIMVR.…”

“…24 Inadequate drainage usually originates with improper positioning of the femoral venous cannula and should be remedied before cross-clamping. Helpful options are found in Wolfe et al 14 Routine bicaval cannulation and drainage is advisable early in the learning curve.…”

“…Careful manipulation of guidewires, dilators, catheters, and cannulae minimizes the risk of aortic dissection and other arterial complications. 25 Please refer to Wolfe et al 14 for details regarding safe peripheral cannulation.…”