Decision Making during the Learning Curve of Minimally Invasive Mitral Valve Surgery: A Focused Review for the Starting Minimally Invasive Surgeon

Abstract

Minimally invasive mitral valve surgery is evolving rapidly since the early 1990’s and is now increasingly adopted as the standard approach for mitral valve surgery. It has a long and challenging learning curve and there are many considerations regarding technique, planning and patient selection when starting a minimally invasive program. In the current review, we provide an overview of all considerations and the decision-making process during the learning curve.

The 7 Pillars of Starting an Endoscopic Cardiac Surgery Program

“…This includes the purchase of special surgical equipment, advanced imaging technologies (i.e., 2-dimensional [2D] or 3-dimensional [3D] thoracoscopes), and dedicated endoscopic instruments and suture devices as well as the establishment of protocols for equipment maintenance, sterilization, and quality control to ensure patient safety and optimal surgical outcomes. Moreover, the more technically demanding aspects of this surgery, with a reduction of the operative working space, the use of long-shafted instruments, and the endoscope view, 9 necessitates a period of specialized training for the surgical, anesthetic, and perfusionist teams.…”

“…A 1 to 2 cm vertical skin incision is made above the groin crease, overlying the femoral vessels. 9 The inguinal ligament is then retracted, the vessel exposed proximally on the common femoral artery, and a 5–0 Prolene purse-string is then placed. The artery is cannulated through this suture using a Seldinger technique.…”