Minimally Invasive and Robotic Mitral Valve Surgery: Methods and Outcomes in a 20-Year Review

Abstract

In the mid- to late-1990s the cardiac surgery community began to apply limited incisions in mitral valve surgery. Ministernotomies and right-sided minithoracotomies were placed instead of the classic midline sternotomy. Adjunct technology such as videoscopy, advanced peripheral cannulation techniques, procedure specific long shafted surgical instruments, as well as surgical robots became available, and the procedures were refined in a stepwise fashion. In 2021, minimally invasive mitral valve repair is routine at many centers around the globe. We reviewed a total of 50 consecutive patient series published on the topic between 1999 and 2019. Three main versions of minimally invasive mitral valve surgery were applied in 20,539 patients. The surgical methods, their specific results, and the cumulative outcome of less invasive mitral valve surgery published over more than 20 years are reported and an integrated view on what less invasive mitral valve surgery can offer is presented.

Keywords

mitral valve repair minimally invasive minithoracotomy videoscopy robotic surgery totally endoscopic mitral valve repair

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References

Karagoz

Bayazit

Battaloglu

et al. Minimally invasive mitral valve surgery: the subxiphoid approach. Ann Thorac Surg 1999; 67: 1328–1333.10355406

McClure

Cohn

Wiegerinck

et al. Early and late outcomes in minimally invasive mitral valve repair: an eleven-year experience in 707 patients. J Thorac Cardiovasc Surg 2009; 137: 70–75.19154906

Svensson

Atik

Cosgrove

et al. Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg 2010; 139: 926–932.19945121

Oezpeker

Barbieri

Hoefer

et al. Mitral valve surgery via partial upper sternotomy: closing the gap between conventional sternotomy and right lateral minithoracotomy. Thorac Cardiovasc Surg 2019; 67: 524–530.30180258

Navia

Cosgrove

. Minimally invasive mitral valve operations. Ann Thorac Surg 1996; 62: 1542–1544.8893611

Cohn

Adams

Couper

et al. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 1997; 226: 421–428.9351710

Casselman

Van Slycke

Wellens

et al. Mitral valve surgery can now routinely be performed endoscopically. Circulation 2003; 108(Suppl 1): II48–II54.12970208

Reichenspurner

Detter

Deuse

et al. Video and robotic-assisted minimally invasive mitral valve surgery: a comparison of the port-access and transthoracic clamp techniques. Ann Thorac Surg 2005; 79: 485–491.15680820

Aybek

Dogan

Risteski

et al. Two hundred forty minimally invasive mitral operations through right minithoracotomy. Ann Thorac Surg 2006; 81: 1618–1624.16631646

10.

Ruttmann

Laufer

Müller

. Development of a minimally invasive mitral valve surgery program: the Innsbruck experience. Eur Surg 2006; 38: 320–325.

11.

Seeburger

Borger

Falk

et al. Minimal invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients. Eur J Cardiothorac Surg 2008; 34: 760–765.18586512

12.

Modi

Rodriguez

Hargrove

et al. Minimally invasive video-assisted mitral valve surgery: a 12-year, 2-center experience in 1178 patients. J Thorac Cardiovasc Surg 2009; 137: 1481–1487.19464468

13.

Suri

Schaff

Meyer

et al. Thoracoscopic versus open mitral valve repair: a propensity score analysis of early outcomes. Ann Thorac Surg 2009; 88: 1185–1190.19766804

14.

Wang

Yang

et al. Mitral valve replacement through a minimal right vertical infra-axillary thoracotomy versus standard median sternotomy. Ann Thorac Surg 2009; 87: 704–708.19231374

15.

Iribarne

Russo

Easterwood

et al. Minimally invasive versus sternotomy approach for mitral valve surgery: a propensity analysis. Ann Thorac Surg 2010; 90: 1471–1478.20971243

16.

Loforte

Luzi

Montalto

et al. Video-assisted minimally invasive mitral valve surgery: external aortic clamp versus endoclamp techniques. Innovations 2010; 5: 413–418.22437636

17.

Grossi

Loulmet

Schwartz

et al. Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair. J Thorac Cardiovasc Surg 2012; 143: 68–70.22285326

18.

Mazine

Pellerin

Lebon

et al. Minimally invasive mitral valve surgery: influence of aortic clamping technique on early outcomes. Ann Thorac Surg 2013; 96: 2116–2222.24035304

19.

Bentala

Heutsb

Vosc

et al. Comparing the endo-aortic balloon and the external aortic clamp in minimally invasive mitral valve surgery. Interact Cardiovasc Thorac Surg 2015; 21: 359–365.26093955

20.

Nishi

Miyata

Motomura

et al. Propensity-matched analysis of minimally invasive mitral valve repair using a nationwide surgical database. Surg Today 2015; 45: 1144–1152.26112649

21.

Glauber

Miceli

Canarutto

et al. Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a 10-year experience in 1604 patients. J Cardiothorac Surg 2015; 10: 181.26643038

22.

Tang

Onaitis

Gaca

et al. Right minithoracotomy versus median sternotomy for mitral valve surgery: a propensity matched study. Ann Thorac Surg 2015; 100: 575–581.26141780

23.

Atluri

Stetson

Hung

et al. Minimally invasive mitral valve surgery is associated with equivalent cost and shorter hospital stay when compared with traditional sternotomy. J Thorac Cardiovasc Surg 2016; 151: 385–388.26432722

24.

Downs

Johnston

LaPar

et al. Minimally invasive mitral valve surgery provides excellent outcomes without increased cost: a multi-institutional analysis. Ann Thorac Surg 2016; 102: 14–21.27041453

25.

Hawkins

Mehaffey

Mullen

et al. A propensity matched analysis of robotic, minimally invasive, and conventional mitral valve surgery. Heart 2018; 104: 1970–1975.29915143

26.

Malvindi

Margari

Mastro

et al. External aortic cross-clamping and endoaortic balloon occlusion in minimally invasive mitral valve surgery. Ann Cardiothorac Surg 2018; 7: 748–754.30598888

27.

Barbero

Krakor

Bentala

et al. Comparison of endoaortic and transthoracic aortic clamping in less-invasive mitral valve surgery. Ann Thorac Surg 2018; 105: 794–798.29289366

28.

Paparella

Fattouch

Moscarelli

et al. Current trends in mitral valve surgery: a multicenter national comparison between full-sternotomy and minimally-invasive approach. Int J Cardiol 2020; 306: 147–151.31810816

29.

Grant

Hickey

Modi

et al. Propensity-matched analysis of minimally invasive approach versus sternotomy for mitral valve surgery. Heart 2019; 105: 783–789.30541760

30.

Maruszewski

Smoczyński

Kowalewski

et al. Pilot study of totally thoracoscopic periareolar approach for minimally invasive mitral valve surgery. Towards even less invasive? Wideochir Inne Tech Maloinwazyjne 2019; 14: 326–332.31119001

31.

Carpentier

Loulmet

Carpentier

et al. Open heart operation under videosurgery and minithoracotomy. First case (mitral valvuloplasty) operated with success. C R Acad Sci III 1996; 319: 219–223.8761668

32.

Grossi

Ribakove

Schwartz

et al. Port-access approach for minimally invasive mitral valve surgery. Oper Tech Thorac Cardiovasc Surg 1998; 3: 32–46.

33.

Taylor

BS.

Vanermen

. Totally endoscopic mitral valve repair. Oper Tech Thorac Cardiovasc Surg 2007; 12: 226–234.

34.

Kim

Yoo

. Totally endoscopic mitral valve repair using a three-dimensional endoscope system: initial clinical experience in Korea. J Thorac Dis 2020; 12: 705–711.32274136

35.

Mohr

Falk

Diegeler

et al. Computer-enhanced “robotic” cardiac surgery: experience in 148 patients. J Thorac Cardiovasc Surg 2001; 121: 842–853.11326227

36.

Tatooles

AJ.

Pappas

PS.

Gordon

et al. Minimally invasive mitral valve repair using the da Vinci robotic system. Ann Thorac Surg 2004; 77: 1978–1984.15172249

37.

Nifong

LW.

Chitwood

WR.

Pappas

et al. Robotic mitral valve surgery: a United States multicenter trial. J Thorac Cardiovasc Surg 2005; 129: 1395–1404.15942584

38.

Folliguet

Vanhuyse

Constantino

et al. Mitral valve repair robotic versus sternotomy. Eur J Cardiothorac Surg 2006; 29: 362–366.16423535

39.

Smith

Stein

Engel

et al. Totally endoscopic mitral valve repair using a robotic-controlled atrial retractor. Ann Thorac Surg 2007; 84: 633–637.17643648

40.

Suri

Burkhart

Daly

et al. Robotic mitral valve repair for all prolapse subsets using techniques identical to open valvuloplasty: establishing the benchmark against which percutaneous interventions should be judged. J Thorac Cardiovasc Surg 2011; 142: 970–979.21911231

41.

Nifong

Rodriguez

Chitwood

. 540 consecutive robotic mitral valve repairs including concomitant atrial fibrillation cryoablation. Ann Thorac Surg 2012; 94: 38–43.22560967

42.

Gao

Yang

Xiao

et al. Robotically assisted mitral valve replacement. J Thorac Cardiovasc Surg 2012; 143: 64–67.

43.

Ramzy

Trento

Cheng

et al. Three hundred robotic-assisted mitral valve repairs: the Cedars-Sinai experience. J Thorac Cardiovasc Surg 2014; 24: 228–235.24199760

44.

Yoo

Kim

Jung

et al. Mitral durability after robotic mitral valve repair: analysis of 200 consecutive mitral regeneration repairs. J Thorac Cardiovasc Surg 2014; 148: 2773–2779.25173122

45.

Murphy

Moss

Binongo

et al. The expanding role of endoscopic robotics in mitral valve surgery: 1,257 consecutive procedures. Ann Thorac Surg 2015; 100: 1675–1682.26296272

46.

Musumeci

Mariscalco

Ranocchi

et al. Transareolar robotic-assisted access to the mitral valve. Innovations 2015; 10: 438–440.26655931

47.

Gillinov

Mihaljevic

Javadikasgari

et al. Early results of robotically assisted mitral valve surgery: analysis of the first 1000 cases. J Thorac Cardiovasc Surg 2018; 155: 82–91.28893396

48.

Kesävuori

Raivio

Jokinen

et al. Early experience with robotic mitral valve repair with intra-aortic occlusion. J Thorac Cardiovasc Surg 2018; 155: 1463–1471.29221742

49.

Kuo

Changb

Hsinge

et al. Robotic mitral valve replacements with bioprosthetic valves in 52 patients: experience from a tertiary referral hospital. Eur J Cardiothorac Surg 2018; 54: 853–859.29617931

50.

Paul

Isaacs

Jalbert

et al. A population-based analysis of robotic-assisted mitral valve repair. Ann Thorac Surg 2015; 99: 1546–1553.25757763

51.

Cao

Wolfenden

Liou

et al. A meta-analysis of robotic vs. conventional mitral valve surgery. Ann Cardiothorac Surg 2015; 4: 305–314.26309839

52.

Tribble

Killinger

Hamran

, et al. Anterolateral thoracotomy as an alternative to repeat median sternotomy for replacement of the mitral valve. Ann Thorac Surg 1995; 59: 255–256.7818344

53.

Gott

Alejo

Cameron

. Mechanical heart valves: 50 years of evolution. Ann Thorac Surg 2003; 76: S2230–S2239.14667692

54.

Loulmet

Carpentier

Cho

et al. Less invasive techniques for mitral valve surgery. J Thorac Cardiovasc Surg 1998; 115: 772–779.9576209

55.

Gammie

Zhao

Peterson

et al. Less-invasive mitral valve operations: trends and outcomes from The Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2010; 90: 1401–1410.

56.

Cheng

Martin

Lal

et al. Minimally invasive versus conventional open mitral valve surgery: a meta-analysis and systematic review. Innovations 2011; 6: 84–103.22437892

57.

Falk

Cheng

Martin

et al. Minimally invasive versus open mitral valve surgery: a consensus statement of the International Society of Minimally Invasive Coronary Surgery (ISMICS) 2010. Innovations 2011; 6: 66–76.22437890

58.

Gammie

Chikwe

Badhwar

et al. Isolated mitral valve surgery: The Society of Thoracic Surgeons Adult Cardiac Surgery Database analysis. Ann Thorac Surg 2018; 106: 716–727.30032907

59.

Modi

Hassan

Chitwood

. Minimally invasive mitral valve surgery: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2008; 34: 943–952.

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