Video-assisted minimally invasive mitral valve surgery: The “micro-mitral” operation

Abstract

Over the past 15 years, repair techniques, improved prostheses, retrograde cardioplegia, and enhanced exposure collectitvely have led to impressive advances in mitral valve surgery. Just as minimally invasive coronary surgery appears efficacious, cardiac valve operations using similar techniques are promising. Recently, Kaneko and associates 1 reported videoscopic examination of the mitral valve during a commissurotomy done via a sternotomyo Early this year, port-access mitral replacements were done in Malaysia by the Stanford team using new aortic balloon occlusive technology. On February 26, 1996, Carpentier successfully performed the first video-assisted mitral valve repair through a minithoracotomy during ventriculai fibrillation. 2 On May 26, 1996, our group performed a direct vision "micro-mitral" valve repair with antegrade cardioplegic arrest through a 2.4-inch incision. Two days later we replaced a rheumatic mitral valve using a video-assisted minimally invasive approach, and this case is the subject of this report.The patient was a 43-year-old man with diabetes and long-standing mitral insufficiency that had progressed to class III heart failure and recent-onset atrial fibrillation. Cardiac catheterization showed normal coronary arteries and a 0.45 ventricular ejection fraction. Transthoracic echocardiography showed an immobile posterior leaflet with type III severe mitral insufficiency. Intraoperative transesophageal echocardiography confirmed the transthoracic study. The patient was intubated with a double-lumen endotracheal tube for single lung ventilation and positioned with the right side of the chest elevated 45 degrees and the pelvis nearly flat. A 2-inch incision was made in the midaxillary line over the fifth rib and a small section was removed. A custom retractor was used to provide operative exposure (Snowden-Pencer Inc.). The pericardium was opened just anterior to the phrenic nerve with thoracoscopy scissors. Specialized instruments were used throughout the operation: however, video access was established by means of standard thoracoscopic techniques. A 10 mm thoracoscopic port was placed posterior and cephalad to the main incision, and a three-chip lighted camera (Linvatec Inc.) was inserted to visualize the limited surgical field.Peripheral cardiopulmonary support (28 ° C

The Minimally Invasive Right Vertical Infra-axillary Lateral Minithoracotomy Approach For The Heart Valve Surgery: Report of 115 Cases

“…(23) In 1996, Carpentier performed the first video-assisted minimally invasive mitral valve surgery (MIMVS) through a mini-thoracotomy (24) and Chitwood introduced the transthoracic aortic clamp. (25) In 1998, Mohr developed a video-assisting port access technology to reduce CPB and cross-clamp times which allowed a better visualization of the valve. (26) Since then, MIMVS has been performed through a wide variety of approaches (hemisternotomy, parasternal incision, mini-thoracotomy, total endoscopically and robotically) with favourable long-term outcomes even in elderly and redo patients when compared with sternotomy despite longer bypass and cross-clamp times.…”

Minimally Invasive Cardiovascular Surgery: Incisions and Approaches

“…2,13 Several years later, Mohr and Chitwood reported the first mitral valve cases performed through a right thoracotomy. 14,15 Since that time, alternative approaches such as hemisternotomy, left thoracotomy, and right minithoracotomy have been developed; of those, the right minithoracotomy is the most widely used in current clinical practice.…”

Percutaneous and Minimally Invasive Valve Procedures

“…Peripheral cannulation with lowprofile, high-flow cannulas and direct transthoracic aortic occlusion with a flexible clamp facilitate this procedure. 74 In most instances, direct visualization of the valve is sufficient, and surgical cameras are not necessary. In a recent study of 241 patients having a small anterolateral thoracotomy in the fourth intercostal space, transthoracic aortic clamping, and direct vision of the mitral valve, midterm results were comparable to those achieved with full sternotomy.…”