Minimally-Invasive Valve Surgery

Abstract

Minimally-invasive approaches have become increasingly important in cardiac valve surgery. Smaller incisions have become commonplace in many major centers. We reviewed the existing literature and present the current state-of-the-art of minimally-invasive valve operations in this paper.

Minimally invasive aortic valve replacement in high risk patient groups

“…Historically, Cosgrove and Cohn were the first clinicians to pioneer smaller incisions for both mitral and aortic procedures (1). Despite longer cardiopulmonary bypass (CPB) times compared to conventional surgery (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12), preservation of the sternal integrity and minimisation of dissection had been advocated to improve the cosmetic result, reduce bleeding, provide better respiratory function, yield shorter hospital stays and therefore lower costs and improved patient satisfaction. A large meta-analysis by Phan et al demonstrated that minimally invasive AVR (mini-AVR) is also associated with a reduced incidence of renal failure and has comparable mortality and morbidity to conventional surgery (13).…”

Aortic valve replacement in patients with a left ventricular ejection fraction ≤35% performed via a minimally invasive right thoracotomy

“…No patient required conversion to sternotomy for inadequate surgical field exposure. The median total mechanical ventilation time and intensive care unit length of stay were 14 (IQR,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and 42 hours (IQR, in the isolated AVR group, and 16.5 hours (IQR, 12-61.5 hours) and 95.5 hours (IQR, in the AVR plus MV surgery group, respectively. The most common post-operative complication was newonset atrial fibrillation, which occurred in 15 (29.4%) isolated AVR and 4 (16.7%) AVR plus MV surgery patients.…”

Staged percutaneous coronary intervention followed by minimally invasive mitral valve surgery versus combined coronary artery bypass graft and mitral valve surgery for two-vessel coronary artery disease and moderate to severe ischemic mitral regurgitation

“…Thus, it is hypothesized that a hybrid approach of PCI+MIVS for concomitant CAD and moderate to severe IMR may reduce the operative risk by permitting the use of two smaller, less invasive procedures. Performing PCI for revascularization permits the use of minimally invasive surgical techniques, which have been demonstrated to reduce post-operative atrial fibrillation, wound infection, and the need for blood products, while decreasing surgical trauma and enhancing post-operative recovery (13,14). In the present study, PCI+MIVS was associated with shorter operative times and fewer intra-operative blood transfusions, as compared with CABG+MVS, in patients with two-vessel CAD and moderate to severe IMR.…”