Mitral Valve Minimally Invasive Surgical Treatment

Abstract

Medical advances have helped the US population live longer with more comorbidities than previously possible. As the aging population expands, the incidence of degenerative heart disease and valvular disease has increased. Mitral valve disease is one of the most common valvular anomalies and often concomitant with aortic valve disease. Due to the center of the heart and association with other comorbidities that increase frailty, many patients are at high surgical risk and necessitate alternative therapeutic options. Up to 50% of patients with moderate to severe mitral regurgitation (MR) are not considered surgical candidates. Medical management in mitral regurgitation has poor outcomes with a 1-year mortality rate of 20%, a 5-year mortality rate of 50%, and a high hospitalization rate due to heart failure.The advent of minimally invasive mitral valve repair in recent years provides a necessary therapeutic option for patients with symptomatic mitral valve disease. Additionally, studies of minimally invasive mitral valve repair have been shown to preserve cardiac structure and function when implemented early. Minimally invasive surgical mitral valve repair has become routine for the treatment of MR. Enhancements of minimally invasive surgical techniques improved surgical trauma and postoperative recovery, resulting in increased acceptance of these techniques. Different minimally invasive techniques include robotic repair, minimally invasive mitral valve surgery using a right mini-thoracotomy, percutaneous edge-to-edge mitral valve repair, and transcatheter mitral valve replacement. Many patients with symptomatic MR have a poor prognosis due to older age and comorbidities. Minimally invasive surgical approaches to mitral valve repair have provided important treatment options in these higher-risk surgical patients. The emergence of transcatheter mitral valve repair and replacement options further pushes the boundary of possibilities. Hence, patients who are not surgical candidates can live longer than previously possible.