Interventional and Minimally invasive mitral valve procedures

Abstract

Cardiac valve surgery operations have historically been performed via a standard median sternotomy and CPB. With the advent of minimally invasive surgery, several new observations regarding the treatment of patients with isolated valve disease have arisen. Over the last decade there has been transformation in the way cardiac surgeons, cardiologists, and patients decide the approach to cardiac therapies. Patients now demand less-invasive procedures with equivalent safety, efficacy, and durability. Any form of new technology must provide better outcome and have better efficiency in terms of safety and durability. If scientific evidence shows that mini-VS results in lower complication rates, surgeons must be trained in these newer techniques. However, with different training backgrounds, patient populations, and surgical approaches, surgeons should use the technique that they believe will result in the best outcome and with which they feel most comfortable. Critically appraising the results of MIMVS has several limitations, based on the paucity of randomised controlled trials and the reliance on single centre case series or few other review papers. Furthermore, the definition of “minimally invasive” is controversial. The STS defines minimally invasive surgery as any procedure not performed with a full sternotomy and CPB; however, this definition does not really fit into valve surgery. There has been almost no doubt that these procedures reduce the length of hospital stay and blood transfusion while at the same time being cosmetically more attractive than the conventional approach. One of the major areas for further research is in the field of neurological outcomes as there has been conflicting data with a wide variation in the reported incidence of stroke, Most of the published series continue to implicate MIMVS done on the beating heart as increasing the risk of perioperative stroke. Further disadvantages with MIMVS are related to the use of femoral cannulation and perfusion, with groin complications (e.g., infections and arterial dissections and haematoma accounting for morbidity unseen with conventional sternotomy. Minimally invasive valve surgery is an evolutionary process, and there must be a well-balanced alignment between the surgeons and the cardiologists to derive the maximal benefit that this technology has to offer. Traditional valve operations enjoy proven long-term success with ever-decreasing morbidity and mortality and remain the gold standard. Minimally invasive surgeries are probably not going to replace the gold standard, but they should present themselves as an alternative for treatment of mitral valve diseases with equal long-term durability.