Minimally Invasive Mitral Valve Repair: From Total Endoscopic To Closed-Chest Robotic

Authors

  • Javier Gallego-Poveda Thoracic Surgery Department, Hospital Lusíadas Lisboa; UMICS, Unit for Minimally Invasive Cardiothoracic Surgery
  • Nelson Paulo UMICS, Unit for Minimally Invasive Cardiothoracic Surgery
  • Mário Jorge Amorim UMICS, Unit for Minimally Invasive Cardiothoracic Surgery
  • Diego González-Rivas UMICS, Unit for Minimally Invasive Cardiothoracic Surgery
  • Elena Sandoval Cardiovascular Surgery Department, Hospital Clínic Barcelona
  • Daniel Pereda Cardiovascular Surgery Department, Hospital Clínic Barcelona
  • André Rato Serviço de Anestesiologia, Hospital Lusíadas, Lisboa, Portugal

DOI:

https://doi.org/10.48729/pjctvs.429

Abstract

Minimally invasive cardiac surgery has evolved over the past few decades, thanks to advancements in technology and surgical techniques. These advancements have allowed surgeons to perform cardiac interventions through small incisions, reducing surgical trauma and improving patient outcomes1. However, despite these advancements, thoracoscopic mitral repair has not been widely adopted by the cardiac surgery community, possibly due to the lack of familiarity with video-assisted procedures1. Over the years, various minimally invasive mitral valve surgery (MIMVS) techniques have been developed to achieve comparable or better results while minimizing surgical trauma. These techniques have evolved from direct-vision procedures performed through a right thoracotomy with a rib retractor to video-directed approaches using long-shafted instruments1. Robotic surgery, introduced in the late 90s, has also played a significant role in mitral valve repair. The da Vinci system, the only robotic platform currently used for cardiac surgery, provides surgeons with enhanced dexterity and high-definition 3D visualization, allowing for precise and accurate procedure2, and is now the preferred approach for mitral repair in many programs3. The first mitral repair using the da Vinci system was performed in Europe by Carpentier and Mohr in 1998, followed by the first mitral replacement by Chitwood in the USA in 20002-4. The advantages of robotic technology allow surgeons to perform complex repair techniques such as papillary muscle repositioning and sliding leaflet plasty4. Studies have shown that robotic mitral surgery results in shorter ICU and hospital stays, better quality of life postoperatively, and improved cosmesis compared to conventional surgery5,6. In our experience, we have also observed significant benefits with robotic surgery, including reduced blood loss and the need for transfusions. This can be attributed to the closed-chest technique, which eliminates the need for a thoracotomy and rib retractor, reducing the risk of bleeding associated with these approaches7. In this article, we will compare the surgical steps of endoscopic and robotic mitral valve repair, providing detailed information on patient selection, operative techniques, and the requirements for building a successful program. By understanding the advantages and challenges of both approaches, surgeons can make informed decisions and provide the best possible care for their patients. Combined ablation and multivalvular procedures are mostly performed in few centers by minimally invasive techniques.

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References

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Published

09-02-2024

How to Cite

1.
Gallego-Poveda J, Paulo N, Amorim MJ, González-Rivas D, Sandoval E, Pereda D, Rato A. Minimally Invasive Mitral Valve Repair: From Total Endoscopic To Closed-Chest Robotic. Rev Port Cir Cardiotorac Vasc [Internet]. 2024 Feb. 9 [cited 2024 Feb. 28];30(4):15-22. Available from: https://pjctvs.com/index.php/journal/article/view/429

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