Minimally Invasive Mitral Valve Surgery: A Systematic Review

Abstract

In the recent years minimally invasive mitral valve surgery (MIMVS) has become a well-established and increasingly used option for managing patients with a mitral valve pathology. Nonetheless, whether the purported benefits of MIMVS translate into clinically important outcomes remains controversial. Therefore, in this paper we provide an overview of MIMVS and discuss results, morbidity, mortality, and quality of life following mitral minimally invasive procedures. MIMVS has been proven to be a feasible alternative to the conventional full sternotomy approach with low perioperative morbidity and short-term mortality. Reported benefits of MIMVS include also decreased postoperative pain, improved postoperative respiratory function, reduced surgical trauma, and greater patient satisfaction. Finally, compared to standard surgery, MIMVS demonstrated comparable efficacy across a range of long-term efficacy measures such as freedom from reoperation and long-term survival.

Minimally invasive mitral valve surgery is associated with a low rate of complications

“…Prospective data collection was approved by the regional Human Research Ethics Committee, Stockholm, Sweden. The patient selection, reflected in the preoperative characteristics of patients, is comparable to other studies . Mean age was 62.9 years, and 21.6% were female.…”

“…There is no evidence suggesting a significant difference in mortality between MIMVS and full‐sternotomy mitral valve surgery. Early mortality has been reported to be similar between the two groups and does not differ between observational and prospective data . In a study comparing 474 MIMVS patients to 337 full‐sternotomy mitral valve surgery patients, perioperative mortality was very low in both groups (0.2–0.3%) .…”

“…Several studies indicate MIMVS to be a safe procedure with excellent short‐ and long‐term outcomes . In several high‐volume centres, MIMVS has therefore become the standard surgical approach for the treatment of mitral valve disease.…”

“…Critics are concerned that MIMVS is technically more demanding with decreased surgical exposure, possibly affecting the repair rate and quality of mitral valve repair . However, several studies have shown MIMVS to have excellent efficacy of valve repair with repair rates and long‐term durability equal to those of full‐sternotomy mitral valve surgery . Mitral valve reoperation rates have been reported to be very low after MIMVS .…”

Percutaneous Transcatheter Mitral Valve Replacement

“…5 In addition, minimally invasive MV surgery has become a well-established and increasingly used option for managing patients with MV pathology. 6 Although surgery remains the gold standard treatment for significant MR, MV surgery is deferred in a large number of patients because of high surgical risk. 7 The decrease in the prevalence of rheumatic valve disease, in combination with an increased life expectancy, has led to a high prevalence of degenerative MR. As a consequence, patients are older and present with comorbidities that increase operative mortality and morbidity risks.…”