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Cardiac surgery
How to establish video assisted, minimally invasive mitral valve surgery
  1. Markus Czesla,
  2. Julia M Götte,
  3. Nicolas Doll
  1. Sana Herzchirurgie Stuttgart GmbH, Stuttgart, Germany
  1. Correspondence to Dr Markus Czesla, Sana Herzchirurgie Stuttgart, Herdweg 2, Stuttgart 70174, Germany; m.czesla{at}

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Changing the surgical routine from standard sternotomy to mini-thoracotomy can prove more challenging than may be first considered. This article describes the advantages and disadvantages, as well as technical details and potential pitfalls, on the way to establishing minimally invasive mitral valve (MV) surgery.

Why minimally invasive?

A smaller cut means a smaller scar. Today's patients show an increasing awareness of invasive methods and procedures. Why saw the sternum into pieces instead of making a 5 cm long incision in the submammary crease? Certainly there are cosmetic issues to consider, especially in younger patients and women, but the major advantages reach far beyond the surface of the skin.

The right lateral mini-thoracotomy approach permits a straight and direct view of the MV and hence provides a significantly improved assessment of its malfunction and critical application of various repair techniques. In patients who require redo MV surgery and have undergone prior MV repair via sternotomy, access to the MV through a lateral thoracotomy approach saves the surgeon from undertaking a difficult dissection and hence lowers the risks of potential harm to the heart and its surrounding structures. The reduction of mortality and morbidity as well as overall surgical trauma, and the more rapid recovery of patients, have been demonstrated in several studies.1–4

However, this procedure requires an entirely different surgical skill set. Integrating video images into the visual feedback, and using long instruments in a narrow and deep surgical field, certainly requires intense training. The technique needs to be performed with perfection in order to minimise certain risks associated with minimally invasive MV surgery, particularly perioperative strokes, aortic dissections, and vascular complications of the femoral vessels.4 The surgeon must be mindful of the consequences of retrograde perfusion when choosing …

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  • Competing interests In compliance with EBAC/EACCME guidelines, all authors participating in Education in Heart have disclosed potential conflicts of interest that might cause a bias in the article. The authors have no competing interests.

  • Provenance and peer review Commissioned; internally peer reviewed.