Key result
Minimally invasive mitral valve surgery via right mini-thoracotomy is indicated in most cases, except when contraindicated by major annular calcification or severe co-morbidities.
Why the study?
What are the indications and contraindications for minimally invasive mitral valve surgery via right mini-thoracotomy compared to partial or full sternotomy?
What are the indications and contraindications for minimally invasive mitral valve surgery via right mini-thoracotomy compared to partial or full sternotomy?
This review outlines the appropriate patient selection for minimally invasive mitral valve surgery, highlighting specific contraindications like major annular calcification where alternative sternotomy approaches are safer.
Answers are grounded in this paper and cite their sources.
May guide mini-thoracotomy selection in most mitral cases; leaves open randomized confirmation versus sternotomy.
A minimally invasive access through right mini-thoracotomy (MT) for mitral valve surgery (MIMVS) is indicated in all cases except those which cannot be safely addressed by this approach, i.e., in particular major annular calcification (MAC). Other conditions to be regarded as contraindications generally either impose an increased risk of complications compared to the standard approach (e.g., severe aorto-iliac atherosclerosis) or may simply jeopardize the results of MIMVS (any co-morbidity imposing an elevated surgical risk). Partial sternotomy (PS) represents an alternative less invasive approach for cases when MT is not feasible including severe MAC, concomitant aortic valve replacement (AVR) and selected indications for coronary artery bypass graft (CABG). Full sternotomy may be reserved for multiple bypass grafting, use of left internal mammary artery (LIMA), right internal mammary artery (RIMA) and reoperations when a MT approach is not appealing.
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Müller et al. (2018) conducted a review in Mitral valve disease requiring surgery. Minimally invasive mitral valve surgery via right mini-thoracotomy vs. Partial or full sternotomy was evaluated. Minimally invasive mitral valve surgery via right mini-thoracotomy is indicated in most cases, except when contraindicated by major annular calcification or severe co-morbidities.
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