Limited-access mitral valve surgery

摘要

Minimally invasive, or limited-access, cardiac surgery has become popular over the past 5 years. Surgeons and patients alike expect excellent results, and early data suggest that these new operations are safe and effective and provide results comparable to those achieved with conventional operations. Elements constituting the ideal mitral valve operation are listed in Table 22.1. To attain these goals, surgeons have adopted an evolutionary implementation pattern. First, conventional approaches were modified and, in some hands, arrived quickly at micro and near port incisions. Then, videoassisted techniques were attempted. At East Carolina University (ECU), we have moved step-wise from using direct vision with smaller incisions (level I), to video assistance (level II), to video-directed, voice-activated robotic techniques (level III), and recently, to complete robotic mitral valve repairs (level IV). This classification was proposed by Loulmet and describes this ascension accurately (Table 22.2). A series of‘camps,’ or comfort levels, has been established premonitory to advancing toward a completely endoscopic mitral valve operation. Although some currently are achieving near endoscopic valve repair/replacements, surgeons should rely on results of longitudinal patient studies before setting a new standard.