Minimally invasive atrioventricular valve surgery – current status and future perspectives

Circumflex Coronary Artery Injury during Modern Mitral Valve Surgery—A Review of Current Concepts and Perspectives

“…In addition to mechanical CX injury, Obarski and colleagues [ 84 ] suggested that water-testing of valve competence following MV repair may potentially result in air embolism and transient CX ischemia, which may resolve or evolve to infarction. Minimally invasive and robotic approaches are becoming increasingly established as excellent surgical alternatives to conventional MV surgery by sternotomy access [ 66 ]. However, the learning curves associated with establishing less invasive surgical programs are well reported [ 67 , 68 , 69 ] and require additional skills in single-shaft and robotic console instrument manipulation.…”

“…This manuscript provides a systematic review of all available reports on CX injury during isolated MV surgery and describes current CX injury prevention and diagnosis and treatment strategies. Less invasive MV surgical approaches that utilize special single shafted instruments under direct, endoscopic or robotic vision [ 66 ] require additional instrument manipulation skills [ 67 , 68 , 69 ] and a thorough understanding of the CX, coronary sinus (CS) and MV surgical anatomy to avoid CX injury during the initial learning curves. Furthermore, reports on the potential incidence and risk of CX injury related to advances in innovative transcatheter MV repair [ 70 , 71 ] and replacement [ 72 , 73 ] technology are also emerging.…”

Minimally Invasive Pectus Excavatum Correction and Endoscopic Port Access Mitral Valve Surgery

“…Contemporary minimally invasive atrioventricular valve surgery (MI-AVVS) that utilizes direct or endoscopic vision, special single-shaft instruments, or innovative robotic technology is well established. 1 Adult patients with indications for MI-AVVS and uncorrected congenital chest wall deformities (CCWD), which include the spectrum of isolated and mixed pectus deformities, present unique intraopera-tive challenges in obtaining adequate valve exposure and unobstructed working angles. 2 Previous reports on how to address these challenges during MI-AVVS have described the use of preoperative computerized tomography to plan minimally invasive atrial retrac-tor and working port positioning 3 and single-stage correction of the CCWD by a modified conventional Ravitch procedure preceding MI-AVVS.…”