Minimally Invasive Surgical Mitral Valve Repair: State of the Art Review

Abstract

Minimally invasive surgical mitral valve repair (MVRepair) has become routine for the treatment of mitral valve regurgitation, and indications have been expanded to include reoperations. Current European Society of Cardiology/European Association for Cardio-Thoracic Surgery guidelines for the management of valvular heart disease recommended standards in terms of mitral valve disease differentiation, timing of intervention and surgical techniques to improve patient care. Numerous minimally invasive techniques to lessen the invasiveness have been described, such as the minimal-access J-sternotomy (ministernotomy), the parasternal incision, the port-access technique and the right minithoracotomy. Despite the development of catheter-based techniques, surgical repair remains the gold standard today for nearly all patients with degenerative valvular diseases and the majority of patients with other types of valvular diseases. Techniques include resection of the prolapsed segment, neo-chordae implantation and ring annuloplasty. In this review, the current indications for mitral valve surgery are summarised and state-of-the-art MVRepair techniques are highlighted.

Recent Applications of Three Dimensional Printing in Cardiovascular Medicine

“…In addition, the possibility of surgeons to practice is limited and most of the pre-surgical training is conducted by assisting and performing real operations [34]. Various surgical repair techniques exist (e.g., annuloplasty, leaflet plasty, chordae plasty), which may address different parts of the valve [35]. Vukicevic and coworkers created patient-specific 3D MV models with different materials starting from TEE and CT imaging datasets.…”

A successful minimally invasive mitral valve repair following delayed device embolization in a patient with Pascal device implantation

“…A minimally invasive periareolar approach was utilized and the mitral valve was visualized using a three-dimensional (3D) endoscope. [5] Intraoperatively, one of the implanted devices was found to be correctly attached to the A1/P1 scallops. Since the device did not show any fibrous encapsulation, the decision to remove the device was taken to preserve the valve integrity for the purpose of possible mitral valve repair (Figure 1g).…”

Comparison of aortic cross-clamping versus beating heart surgery in tricuspid valve repair

“…[3] The benefit of tricuspid valve repair (TVr) during concomitant mitral valve surgery has been recently well-documented in large-scale observational studies. [4,5] However, despite growing number of studies investigating the evolution of secondary TR, there has been an ongoing debate about the optimum surgical techniques and myocardial protection methods for TR in complex cardiac surgery.…”

“…Other reason was possible heterogeneity of TVr techniques. [5] To date, several tricuspid annular stabilization techniques have been described, mainly DeVega, Revuelta and Garcia-Rinaldi, Dubost, Sagban, Sarray and Duarte, Kay, Modified Kay, and ring annuloplasty with a flexible or rigid rings. [5] Further leaflet repair techniques can be also added to annular stabilization including the Clover technique, leaflet augmentation, double orifice, or Gore-Tex loops.…”

“…[5] To date, several tricuspid annular stabilization techniques have been described, mainly DeVega, Revuelta and Garcia-Rinaldi, Dubost, Sagban, Sarray and Duarte, Kay, Modified Kay, and ring annuloplasty with a flexible or rigid rings. [5] Further leaflet repair techniques can be also added to annular stabilization including the Clover technique, leaflet augmentation, double orifice, or Gore-Tex loops. [5] Over the past decade, our valvular heart program has liberally included ring annuloplasty for concomitant TV disease either on beating heart (BH) or during aortic cross-clamping (ACC) to avoid irreversible right ventricular (RV) dysfunction.…”