Minimally Invasive Mitral Valve Repair/Replacement

Video-assisted minimally invasive mitral valve repair through a mini-thoracotomy was described 25 years ago, and it is now the “standard” approach in many expert mitral valve repair centers. The technique is safe and efficient and its superiority to conventional sternotomy has been demonstrated in terms of postoperative bleeding, ICU and length of hospital stays. Results of the technique still remain dependent on the surgeon mastering the technique despite a steep learning curve. In the following manuscript, we provide a comprehensive description of our surgical protocol. The promotion of a standardized protocol is a key element to ease the coordination of the anesthesia, nursing and surgical teams. A dedicated instrumentation is required. A percutaneous and bilateral femoral cannulation is always performed. The surgical access (anterolateral right mini-thoracotomy) is essential and drives the valvular access. Some simple maneuvers must be used to obtain a perfect valvular exposure, which is necessary in order to apply dedicated mitral valve repair techniques.