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DOI: 10.1055/s-2008-1037936
Patient selection for minimally invasive mitral valve surgery
Aims: Videoassisted minimally invasive mitral valve repair (mini-MVP) or replacement (mini-MVR) through a 5–6cm thoracotmy is still limited to few centers. To elucidate the process of indicating the minimally invasive approach we retrospectively investigated our patients from 2005 to 2007.
Methods: 325 patients were found eligible as they needed neither additional CABG nor aortic valve replacement (AVR). Patients having ASD or PFO closure, afib surgery or tricuspid valve plasty (TVP), however, were also included in this analysis.
Results: 191 patients had median sternotomy, 74 had minimally invasive surgery. In 2005, 2006 and 2007 24%, 43% and 47% respectively were operated minimally invasive. In 77% of these patients isolated surgery of the mitral valve only was performed, 23% had additional TVP, a modified MAZE procedure or PFO closure. Mitral pathology included PML only in 52%, AML only in 15%, both leaflets in 20%, isolated annular dilatation in 7% and stenosis in 6%. In 93% mini-MVP in 7% mini-MVR was performed. Conversion from MVP to MVR or to median sternotomy was necessary in one patient respectively. 97% had grade 0–1 residual regurgitation, 3% grade 2, but no grade 3 or 4. Annular calcification was found inappropriate for a minimally invasive procedure.
Conclusion: Except non valvular contraindications like simultaneous AVR, CABG, PVD, severe pulmonary disease etc. few contraindications for minimally invasive mitral valve surgery exist. Most pathologies including severe Barlow, Carpentier type IIIa regurgitation, double valve disease and atrial fibrillation can be treated successfully by minimally invasive access.