Minimally invasive mitral valve surgery: a review of the literature

Purpose

Minimally invasive mitral valve surgery (MIMVS) is a heterogenous concept referring to a gamut of surgical approaches to the mitral valve. When compared to conventional sternotomy (CONV-ST), MIMVS appears to offer superior patient satisfaction and recovery time. However, published results differ between institutions due to variations in technique, and mid- to long-term data is relatively scant. Despite the limitations of the evidence base, patient demand for minimally invasive operations remains strong. This demand is only likely to rise in the future as surgery is being recommended earlier in the course of disease and patients are referred for operation at a younger age. This review therefore isolates each MIMVS technique to evaluate its place in current surgical practice, as well as areas of future research.

Methods

A comprehensive literature search was performed using MEDLINE, Embase, Google Scholar, and Scopus. Search terms included ‘minimally invasive surgical procedures’, ‘mitral valve’, ‘sternotomy’, ‘thoracotomy’, ‘mitral valve repair’, and ‘mitral valve replacement’. Articles were also gathered from other sources, including manual searches through reference lists of articles and recommended ‘related articles’.

Summary

MIMVS has evolved from using smaller incisions to endoscopic surgery, robotics, and, most recently, percutaneous off-pump procedures. It is now standard practice at centres around the world. At present, the right minithoracotomy is the most common approach, though robotic and percutaneous techniques are suitable for certain patients. Collaboration between cardiothoracic surgeons, interventional cardiologists, and other disciplines will be essential in furthering the newest minimally invasive techniques. Future research should depend on long-term data, broad patient sampling, and high-tier evidence.