Minimally Invasive Mitral Valve Surgery: An Update

Minimally invasive mitral valve surgery (MIMVS) was introduced in the mid-1990s to refer to a variety of surgical techniques that avoid full sternotomy through smaller or alternative chest wall incisions, as an attempt to reduce complications, but at the same time preserve outcomes of the full sternotomy approach. In this review, different aspects of MIMVS are discussed in relation to its approaches (right parasternal incision, lower ministernotomy, right anterolateral minithoracotomy and left posterior minithoracotomy) as well as strategies (mini-incisions, video-assistance, video direction with robotic assistance and telemanipulation) passing through more than 2 decades of continuous evolution. In the current practice MIMVS shows similar outcome to conventional surgery with even more superior results regarding blood loss, ICU and hospital stay, as well as functional recovery. The accumulating experience with MIMVS encouraged surgeons to extend the application of these techniques to high-risk patients, redo surgeries, concomitant double or triple valve procedures as well as combined coronary artery and mitral valve diseases in a hybrid approach, reducing the need for full median sternotomy. In addition there is an emerging trend of transcatheter valve implantation in the mitral position with small reports of valve-in valve or valve-in- ring implantation as well as valve replacement in case of severe MAC. This new trend may establish itself in the future as a modality in treating native mitral valve diseases in high risk patients. Therefore it is recommended for cardiac centers to build up a program for MIMVS in order to fulfill the recent requirements of cardiac surgery.