Minimally Invasive Mitral Valve Surgery via Right Minithoracotomy

  • Jamshid H. KarimovEmail author
  • Mattia Glauber


Mitral valve (MV) disease is the most prevalent form of heart valve disease with an age-related increase in incidence. Surgical valve repair or replacement is the only treatment for mitral regurgitation with defined clinical success. The conventional surgical correction of significant valvular regurgitation usually consists of repair or replacement of the MV through a median full-length sternotomy, which remains the “classic” approach for the majority of procedures involving the MV.

From early experience in MV surgery, several types of surgical access were established: through left and right anterolateral thoracotomy for closed and correspondingly for open mitral commissurotomy, from right parasternal access with rib resection, and through a full median sternotomy. These methods have been studied and evaluated by cardiac surgeons through the years to establish known benefits and drawbacks. Factors influencing the choice of access have included improved working field exposure, visualization, ergonomics and cosmetic outcomes, and superior preservation of the structural and morphological integrity of tissues.

Applying technological development to successful basic cardiac surgical techniques has led to the introduction of minimally invasive approaches to cardiac valve procedures. Today, as an alternative to conventional surgical approaches, the minimally invasive surgical technique in the treatment of heart valve diseases has become a rapidly evolving field offering several advantages including reduced postoperative pain, decreased morbidity and mortality, faster recovery, shorter hospital stays, reduced costs, and improved cosmetic appearance at the incision site. Currently, the most innovative minimally invasive techniques include port-access valve surgery, achieved through a small minithoracotomy and performed as either direct-vision, video-assisted, or robotically assisted valve surgery through the right minithoracotomy.

In our institution, port-access surgery concepts and technique was initially introduced for minimally invasive repair and replacement in isolated MV diseases. Today, we perform the majority of our isolated mitral procedures and also concomitant tricuspid and/or aortic valve surgeries through the minithoracotomy using direct and/or video-assisted approach. In this chapter, we will focus on the minimally invasive surgical techniques used in surgery today for performing MV surgery through a right minithoracotomy.


Mitral Valve Mitral Valve Repair Mitral Valve Surgery Venous Cannula Aortic Cannulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. 1.
    Nkomo VT, Gardin JM, Skelton TN, Gottdieneri JS, Scott CG, Enriquez-Sarano M (2006) Burden of valvular heart diseases: a population-based study. Lancet 368(9540):1005–1011PubMedCrossRefGoogle Scholar
  2. 2.
    Iung B, Baron G, Butchart EG, Delahaye F, Gohlke-Bärwolf C, Levang OW, Tornos P, Vanoverschelde JL, Vermeer F, Boersma E, Ravaud P, Vahanian A (2003) A prospective survey of patients with valvular heart disease in Europe: the euro heart survey on valvular heart disease. Eur Heart J 24(13):1231–1243PubMedCrossRefGoogle Scholar
  3. 3.
    Chandrashekhar Y, Westaby S, Narula J (2009) Mitral stenosis. Lancet 374(9697):1271–1283PubMedCrossRefGoogle Scholar
  4. 4.
    Enriquez-Sarano M, Akins CW, Vahanian A (2009) Mitral regurgitation. Lancet 373(9672):1382–1394PubMedCrossRefGoogle Scholar
  5. 5.
    Rankin JS, Hammill BG, Ferguson TB Jr, Glower DD, O’Brien SM, DeLong ER, Peterson ED, Edwards FH (2006) Determinants of operative mortality in valvular heart surgery. J Thorac Cardiovasc Surg 131(3):547–557PubMedCrossRefGoogle Scholar
  6. 6.
    Roger VL, Go AS, Lloyd-Jones DM, Benjamin EJ, Berry JD, Borden WB, Bravata DM, Dai S, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Hailpern SM, Heit JA, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Soliman EZ, Sorlie PD, Sotoodehnia N, Turan TN, Virani SS, Wong ND, Woo D, Turner MB, American Heart Association Statistics Committee and Stroke Statistics Subcommittee (2012) Heart disease and stroke statistics – 2012 update: a report from the American Heart Association. Circulation 125(1):e2–e220PubMedCrossRefGoogle Scholar
  7. 7.
    Navia JL, Cosgrove DM 3rd (1996) Minimally invasive mitral valve operations. Ann Thorac Surg 62(5):1542–1544PubMedCrossRefGoogle Scholar
  8. 8.
    Grossi EA, Galloway AC, Ribakove GH, Buttenheim PM, Esposito R, Baumann FG, Colvin SB (1999) Minimally invasive port access surgery reduces operative morbidity for valve replacement in the elderly. Heart Surg Forum 2(3):212–215PubMedGoogle Scholar
  9. 9.
    Pompili MF, Stevens JH, Burdon TA, Siegel LC, Peters WS, Ribakove GH, Reitz BA (1996) Port-access mitral valve replacement in dogs. J Thorac Cardiovasc Surg 112(5):1268–1274PubMedCrossRefGoogle Scholar
  10. 10.
    Peters WS, Smith JA, Preovolos A, Rabinov M, Buckland MR, Rosenfeldt FL (1997) Mitral valve replacement via a right mini-thoracotomy in the dog: use of carbon dioxide to reduce intracardiac air. Eur J Cardiothorac Surg 11(6):1067–1073PubMedCrossRefGoogle Scholar
  11. 11.
    Schwartz DS, Ribakove GH, Grossi EA, Buttenheim PM, Schwartz JD, Applebaum RM, Kronzon I, Baumann FG, Colvin SB, Galloway AC (1997) Minimally invasive mitral valve replacement: port-access technique, feasibility, and myocardial functional preservation. J Thorac Cardiovasc Surg 113(6):1022–1030; discussion 1030–1031PubMedCrossRefGoogle Scholar
  12. 12.
    Carpentier A, Loulmet D, Carpentier A, Le Bret E, Haugades B, Dassier P, Guibourt P (1996) Open heart operation under videosurgery and minithoracotomy. First case (mitral valvuloplasty) operated with success. C R Acad Sci III 319(3):219–223PubMedGoogle Scholar
  13. 13.
    Loulmet DF, Carpentier A, Cho PW, Berrebi A, d’Attellis N, Austin CB, Couëtil JP, Lajos P (1998) Less invasive techniques for mitral valve surgery. J Thorac Cardiovasc Surg 115(4):772–779PubMedCrossRefGoogle Scholar
  14. 14.
    Greco E, Zaballos JM, Alvarez L, Urso S, Pulitani I, Sàdaba R, Juaristi A, Goiti JJ (2008) Video-assisted mitral surgery through a micro-access: a safe and reliable reality in the current era. J Heart Valve Dis 17(1):48–53PubMedGoogle Scholar
  15. 15.
    Iribarne A, Russo MJ, Easterwood R, Hong KN, Yang J, Cheema FH, Smith CR, Argenziano M (2010) Minimally invasive versus sternotomy approach for mitral valve surgery: a propensity analysis. Ann Thorac Surg 90(5):1471–1477; discussion 1477–1478PubMedCrossRefGoogle Scholar
  16. 16.
    Iribarne A, Easterwood R, Chan EY, Yang J, Soni L, Russo MJ, Smith CR, Argenziano M (2011) The golden age of minimally invasive cardiothoracic surgery: current and future perspectives. Future Cardiol 7(3):333–346PubMedCrossRefGoogle Scholar
  17. 17.
    Schroeyers P, Wellens F, De Geest R, Degrieck I, Van Praet F, Vermeulen Y, Vanermen H (2001) Minimally invasive video-assisted mitral valve surgery: our lessons after a 4-year experience. Ann Thorac Surg 72(3):S1050–S1054PubMedCrossRefGoogle Scholar
  18. 18.
    Galloway AC, Shemin RJ, Glower DD, Boyer JH Jr, Groh MA, Kuntz RE, Burdon TA, Ribakove GH, Reitz BA, Colvin SB (1999) First report of the port access international registry. Ann Thorac Surg 67(1):51–56; discussion 57–58PubMedCrossRefGoogle Scholar
  19. 19.
    Mohr FW, Falk V, Diegeler A, Walther T, van Son JA, Autschbach R (1998) Minimally invasive port-access mitral valve surgery. J Thorac Cardiovasc Surg 115(3):567–574; discussion 574–576PubMedCrossRefGoogle Scholar
  20. 20.
    Glower DD, Clements FM, Debruijn NP, Stafford-Smith M, Davis RD, Landolfo KP, Smith PK (1999) Comparison of direct aortic and femoral cannulation for port-access cardiac operations. Ann Thorac Surg 68(4):1529–1531PubMedCrossRefGoogle Scholar
  21. 21.
    Chitwood WR Jr, Elbeery JR, Moran JF (1997) Minimally invasive mitral valve repair using transthoracic aortic occlusion. Ann Thorac Surg 63(5):1477–1479PubMedCrossRefGoogle Scholar
  22. 22.
    Aybek T, Dogan S, Wimmer-Greinecker G, Westphal K, Mortiz A (2000) The micro-mitral operation comparing the port-access technique and the transthoracic clamp technique. J Card Surg 15(1):76–81PubMedCrossRefGoogle Scholar
  23. 23.
    Casselman FP, Van Slycke S, Wellens F, De Geest R, Degrieck I, Van Praet F, Vermeulen Y, Vanermen H (2003) Mitral valve surgery can now routinely be performed endoscopically. Circulation 108(Suppl 1):II48–II54PubMedGoogle Scholar
  24. 24.
    Reichenspurner H, Detter C, Deuse T, Boehm DH, Treede H, Reichart B (2005) Video and robotic-assisted minimally invasive mitral valve surgery: a comparison of the port-access and transthoracic clamp techniques. Ann Thorac Surg 79(2):485–490; discussion 490–491PubMedCrossRefGoogle Scholar
  25. 25.
    Gulielmos V, Wagner FM, Waetzig B, Solowjowa N, Tugtekin SM, Schroeder C, Schueler S (1999) Clinical experience with minimally invasive coronary artery and mitral valve surgery with the advantage of cardiopulmonary bypass and cardioplegic arrest using the port access technique. World J Surg 23(5):480–485PubMedCrossRefGoogle Scholar
  26. 26.
    Gulielmos V, Tugtekin SM, Kappert U, Cichon R, Matschke K, Karbalai P, Schueler S (2000) Three-year follow-up after port-access mitral valve surgery. J Card Surg 15(1):43–50PubMedCrossRefGoogle Scholar
  27. 27.
    Grossi EA, Zakow PK, Ribakove G, Kallenbach K, Ursomanno P, Gradek CE, Baumann FG, Colvin SB, Galloway AC (1999) Comparison of post-operative pain, stress response, and quality of life in port access vs. standard sternotomy coronary bypass patients. Eur J Cardiothorac Surg 16(Suppl 2):S39–S42PubMedCrossRefGoogle Scholar
  28. 28.
    Svensson LG, Atik FA, Cosgrove DM, Blackstone EH, Rajeswaran J, Krishnaswamy G, Jin U, Gillinov AM, Griffin B, Navia JL, Mihaljevic T, Lytle BW (2010) Minimally invasive versus conventional mitral valve surgery: a propensity-matched comparison. J Thorac Cardiovasc Surg 139(4):926-32.e1–926-32.e2CrossRefGoogle Scholar
  29. 29.
    Dogan S, Aybek T, Risteski PS, Detho F, Rapp A, Wimmer-Greinecker G, Moritz A (2005) Minimally invasive port access versus conventional mitral valve surgery: prospective randomized study. Ann Thorac Surg 79(2):492–498PubMedCrossRefGoogle Scholar
  30. 30.
    Wimmer-Greinecker G, Matheis G, Dogan S, Aybek T, Kessler P, Westphal K, Moritz A (1999) Complications of port-access cardiac surgery. J Card Surg 14(4):240–245PubMedCrossRefGoogle Scholar
  31. 31.
    Seeburger J, Borger MA, Falk V, Kuntze T, Czesla M, Walther T, Doll N, Mohr FW (2008) Minimal invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients. Eur J Cardiothorac Surg 34(4):760–765PubMedCrossRefGoogle Scholar
  32. 32.
    Walther T, Falk V, Metz S, Diegeler A, Battellini R, Autschbach R, Mohr FW (1999) Pain and quality of life after minimally invasive versus conventional cardiac surgery. Ann Thorac Surg 67(6):1643–1647PubMedCrossRefGoogle Scholar
  33. 33.
    Glower DD, Landolfo KP, Clements F, Debruijn NP, Stafford-Smith M, Smith PK, Duhaylongsod F (1998) Mitral valve operation via port access versus median sternotomy. Eur J Cardiothorac Surg 14(Suppl 1):S143–S147PubMedCrossRefGoogle Scholar
  34. 34.
    Chitwood WR Jr, Wixon CL, Elbeery JR, Francalancia NA, Lust RM (1999) Minimally invasive cardiac operation: adapting cardioprotective strategies. Ann Thorac Surg 68(5):1974–1977PubMedCrossRefGoogle Scholar
  35. 35.
    Aklog L, Adams DH, Couper GS, Gobezie R, Sears S, Cohn LH (1998) Techniques and results of direct-access minimally invasive mitral valve surgery: a paradigm for the future. J Thorac Cardiovasc Surg 116(5):705–715PubMedCrossRefGoogle Scholar
  36. 36.
    Grossi EA, Ribakove G, Schwartz DS, Galloway AC, Colvin SB (1998). Port-access approach for minimally invasive mitral valve surgery. Operative Techniques in Cardiac and Thoracic Surgery 2;3(1):32–46.Google Scholar
  37. 37.
    Yozu R, Okamoto K, Kudo M, Nonaka H, Adams DH (2012) New innovative instruments facilitate both direct-vision and endoscopic-assisted mini-mitral valve surgery. J Thorac Cardiovasc Surg 143(4 Suppl):S82–S85PubMedCrossRefGoogle Scholar
  38. 38.
    Greco E, Barriuso C, Castro MA, Fita G, Pomar JL (2002) Port-access cardiac surgery: from a learning process to the standard. Heart Surg Forum 5(2):145–149PubMedGoogle Scholar
  39. 39.
    Woo YJ, Rodriguez E, Atluri P, Chitwood WR Jr (2006) Minimally invasive, robotic, and off-pump mitral valve surgery. Semin Thorac Cardiovasc Surg 18(2):139–147PubMedCrossRefGoogle Scholar
  40. 40.
    Schmitto JD, Mokashi SA, Cohn LH (2011) Past, present, and future of minimally invasive mitral valve surgery. J Heart Valve Dis 20(5):493–498PubMedGoogle Scholar
  41. 41.
    Grossi EA, Galloway AC, LaPietra A, Ribakove GH, Ursomanno P, Delianides J, Culliford AT, Bizekis C, Esposito RA, Baumann FG, Kanchuger MS, Colvin SB (2002) Minimally invasive mitral valve surgery: a 6-year experience with 714 patients. Ann Thorac Surg 74(3):660–663; discussion 663–664PubMedCrossRefGoogle Scholar
  42. 42.
    Aybek T, Dogan S, Risteski PS, Zierer A, Wittlinger T, Wimmer-Greinecker G, Moritz A (2006) Two hundred forty minimally invasive mitral operations through right minithoracotomy. Ann Thorac Surg 81(5):1618–1624PubMedCrossRefGoogle Scholar
  43. 43.
    Chu JJ, Chang CH, Lin PJ, Liu HP, Tsai FC, Wu D, Chiang CW, Lin FC, Su WJ, Tan PP (1998) Video-assisted cardiac surgery: preliminary results in Chang Gung Memorial Hospital. Chin Med J (Engl) 111(5):422–427Google Scholar
  44. 44.
    Poffo R, Pope RB, Selbach RA, Mokross CA, Fukuti F, Id SJ, Agapito A, Cidral I (2009) Video-assisted cardiac surgery: results from a pioneer project in Brazil. Rev Bras Cir Cardiovasc 24(3):318–326PubMedCrossRefGoogle Scholar
  45. 45.
    Raanani E, Spiegelstein D, Sternik L, Preisman S, Moshkovitz Y, Smolinsky AK, Shinfeld A (2010) Quality of mitral valve repair: median sternotomy versus port-access approach. J Thorac Cardiovasc Surg 140(1):86–90PubMedCrossRefGoogle Scholar
  46. 46.
    Glauber M, Karimov JH, Farneti PA, Cerillo AG, Santarelli F, Ferrarini M, Del Sarto P, Murzi M, Solinas M (2008) Minimally invasive mitral valve surgery via right minithoracotomy. Multimedia Man Cardiothorac Surg. doi: 10.1510/mmcts.2008.003350
  47. 47.
    Mishra YK, Khanna SN, Wasir H, Sharma KK, Mehta Y, Trehan N (2005) Port-access approach for cardiac surgical procedures: our experience in 776 patients. Indian Heart J 57(6):688–693PubMedGoogle Scholar
  48. 48.
    Schroeyers P, Wellens F, De Geest R, Degrieck I, Van Praet F, Vermeulen Y, Vanermen H (2001) Minimally invasive video-assisted mitral valve repair: short and mid-term results. J Heart Valve Dis 10(5):579–583PubMedGoogle Scholar
  49. 49.
    Kypson AP, Glower DD (2002) Port-access approach for combined aortic and mitral valve surgery. Ann Thorac Surg 73(5):1657–1658PubMedCrossRefGoogle Scholar
  50. 50.
    Karimov JH, Solinas M, Latsuzbaia K, Murzi M, Cerillo AG, Glauber M (2009) Surgical treatment of double and triple heart valve disease through a limited single-access right minithoracotomy. Multimedia Man Cardiothoracic Surg. doi: 10.1510/mmcts.2009.004036
  51. 51.
    Trehan N, Mishra YK, Mathew SG, Sharma KK, Shrivastava S, Mehta Y (2002) Redo mitral valve surgery using the port-access system. Asian Cardiovasc Thorac Ann 10(3):215–218PubMedGoogle Scholar
  52. 52.
    Meyer SR, Szeto WY, Augoustides JG, Morris RJ, Vernick WJ, Paschal D, Fox J, Hargrove WC 3rd (2009) Reoperative mitral valve surgery by the port access minithoracotomy approach is safe and effective. Ann Thorac Surg 87(5):1426–1430PubMedCrossRefGoogle Scholar
  53. 53.
    Murzi M, Kallushi E, Tiwari KK, Cerillo AG, Bevilacqua S, Karimov JH, Solinas M, Glauber M (2009) Minimally invasive mitral valve surgery through right thoracotomy in patients with patent coronary artery bypass grafts. Interact Cardiovasc Thorac Surg 9(1):29–32PubMedCrossRefGoogle Scholar
  54. 54.
    Karimov JH, Bevilacqua S, Solinas M, Glauber M (2009) Triple heart valve surgery through a right antero-lateral minithoracotomy. Interact Cardiovasc Thorac Surg 9(2):360–362PubMedCrossRefGoogle Scholar
  55. 55.
    Solinas M, Bevilacqua S, Karimov JH, Glauber M (2010) A left atrial ablation with bipolar irrigated radio-frequency for atrial fibrillation during minimally invasive mitral valve surgery. Eur J Cardiothorac Surg 37(4):965–966PubMedCrossRefGoogle Scholar
  56. 56.
    Jeanmart H, Casselman FP, De Grieck Y, Bakir I, Coddens J, Foubert L, Van Vaerenbergh G, Vermeulen Y, Vanermen H (2007) Avoiding vascular complications during minimally invasive, totally endoscopic intracardiac surgery. J Thorac Cardiovasc Surg 133(4):1066–1070PubMedCrossRefGoogle Scholar
  57. 57.
    Saunders PC, Grossi EA, Sharony R, Schwartz CF, Ribakove GH, Culliford AT, Delianides J, Baumann FG, Galloway AC, Colvin SB (2004) Minimally invasive technology for mitral valve surgery via left thoracotomy: experience with forty cases. J Thorac Cardiovasc Surg 127(4):1026–1031; discussion 1031–1032PubMedCrossRefGoogle Scholar
  58. 58.
    Modi P, Rodriguez E, Hargrove WC 3rd, Hassan A, Szeto WY, Chitwood WR Jr (2009) Minimally invasive video-assisted mitral valve surgery: a 12-year, 2-center experience in 1178 patients. J Thorac Cardiovasc Surg 137(6):1481–1487PubMedCrossRefGoogle Scholar
  59. 59.
    Onnasch JF, Schneider F, Falk V, Mierzwa M, Bucerius J, Mohr FW (2002) Five years of less invasive mitral valve surgery: from experimental to routine approach. Heart Surg Forum 5(2):132–135PubMedGoogle Scholar
  60. 60.
    Holzhey DM, Shi W, Borger MA, Seeburger J, Garbade J, Pfannmüller B, Mohr FW (2011) Minimally invasive versus sternotomy approach for mitral valve surgery in patients greater than 70 years old: a propensity-matched comparison. Ann Thorac Surg 91(2):401–405PubMedCrossRefGoogle Scholar
  61. 61.
    Mishra YK, Malhotra R, Mehta Y, Sharma KK, Kasliwal RR, Trehan N (1999) Minimally invasive mitral valve surgery through right anterolateral minithoracotomy. Ann Thorac Surg 68(4):1520–1524PubMedCrossRefGoogle Scholar
  62. 62.
    Grossi EA, Ribakove G, Galloway AC, Colvin SB (2000) Minimally invasive mitral valve surgery with endovascular balloon technique. Operative Techniques in Thoracic and Cardiovascular Surgery 8;5(3):176–89.CrossRefGoogle Scholar
  63. 63.
    Lebon JS, Couture P, Rochon AG, Laliberté E, Harvey J, Aubé N, Cossette M, Bouchard D, Jeanmart H, Pellerin M (2010) The endovascular coronary sinus catheter in minimally invasive mitral and tricuspid valve surgery: a case series. J Cardiothorac Vasc Anesth 24(5):746–751PubMedCrossRefGoogle Scholar
  64. 64.
    Colvin SB, Grossi EA, Ribakove G, Galloway AC (2000) Minimally invasive aortic and mitral valve operation. Oper Tech Card Thorac Surg 5:212–220CrossRefGoogle Scholar
  65. 65.
    Chaney MA, Nikolov MP, Tuchek M, Bakhos M (1998) An institution’s initial experience with port-access minimally invasive cardiac surgery. J Cardiothorac Vasc Anesth 12(6):617–619PubMedCrossRefGoogle Scholar
  66. 66.
    Saroul C, Keller G, Benaissa M, Lehot JJ (2011) Anesthesia for minimally invasive cardiac procedure. Ann Fr Anesth Reanim 30(Suppl 1):S38–S43PubMedGoogle Scholar
  67. 67.
    Secknus MA, Asher CR, Scalia GM, Cosgrove DM 3rd, Stewart WJ (1999) Intraoperative transesophageal echocardiography in minimally invasive cardiac valve surgery. J Am Soc Echocardiogr 12(4):231–236PubMedCrossRefGoogle Scholar
  68. 68.
    Lecharny J-B, Paquin S, de Vaumas C, Philip I (1998) Monitoring by transoesophageal echocardiography in minimally invasive cardiac surgery. Baillière’s Clin Anaesthesiol 12:637–646CrossRefGoogle Scholar
  69. 69.
    Schmitz C, Ashraf O, Bimmel D, Welz A (2002) Direct aortic cannulation in minimally invasive mitral-valve operations. Heart Surg Forum 5(4):370–372PubMedGoogle Scholar
  70. 70.
    Glauber M, Karimov JH (2010) A completely detachable aortic clamping instrument for minimally invasive cardiac surgery. Innovations 5(4):309–310PubMedGoogle Scholar
  71. 71.
    Glower DD, Desai B (2010) Transaortic endoclamp for mitral valve operation through right minithoracotomy in 369 patients. Ann Surg 5(6):394–399Google Scholar
  72. 72.
    Lee TC, Desai BS, Milano C, Jaggers J, Glower DD (2010) Comparison of minithoracotomy versus sternotomy in 304 consecutive tricuspid valve operations. Innovations (Phila) 5(1):3–6CrossRefGoogle Scholar
  73. 73.
    Umakanthan R, Leacche M, Petracek MR, Kumar S, Solenkova NV, Kaiser CA, Greelish JP, Balaguer JM, Ahmad RM, Ball SK, Hoff SJ, Absi TS, Kim BS, Byrne JG (2008) Safety of minimally invasive mitral valve surgery without aortic cross-clamp. Ann Thorac Surg 85(5):1544–1549; discussion 1549–1550PubMedCrossRefGoogle Scholar
  74. 74.
    Kumar S, Petracek MR, Greelish JP, Ahmad RM, Balaguer JM, Byrne JG (2007) Ultra minimally invasive mitral valve surgery without aortic cross-clamp. Heart Lung Circ 16(Suppl 1):S16CrossRefGoogle Scholar
  75. 75.
    Svensson LG, Gillinov AM, Blackstone EH, Houghtaling PL, Kim KH, Pettersson GB, Smedira NG, Banbury MK, Lytle BW (2007) Does right thoracotomy increase the risk of mitral valve reoperation? J Thorac Cardiovasc Surg 134(3):677–682PubMedCrossRefGoogle Scholar
  76. 76.
    Braathen B, Jeppsson A, Scherstén H, Hagen OM, Vengen Ø, Rexius H, Lepore V, Tønnessen T (2011) One single dose of histidine-tryptophan-ketoglutarate solution gives equally good myocardial protection in elective mitral valve surgery as repetitive cold blood cardioplegia: a prospective randomized study. J Thorac Cardiovasc Surg 141(4):995–1001PubMedGoogle Scholar
  77. 77.
    Viana FF, Shi WY, Hayward PA, Larobina ME, Liskaser F, Matalanis G (2012) Custodiol versus blood cardioplegia in complex cardiac operations: an Australian experience. Eur J Cardiothorac Surg [Epub ahead of print] PubMed PMID: 22665382Google Scholar
  78. 78.
    Chaudhuri K, Guddati R, Nawata K, Bhuyan R, Sawada T, Crouch G, Worthington M, Stuklis R, Edwards J (2011) Technical aspects of CO2 gas insufflation in minimally invasive mitral valve surgery. Heart Lung Circ 20:794CrossRefGoogle Scholar
  79. 79.
    Chaudhuri K, Storey E, Lee GA, Bailey M, Chan J, Rosenfeldt FL, Pick A, Negri J, Gooi J, Zimmet A, Esmore D, Merry C, Rowland M, Lin E, Marasco SF (2012) Carbon dioxide insufflation in open-chamber cardiac surgery: a double-blind, randomized clinical trial of neurocognitive effects. J Thorac Cardiovasc Surg [Epub ahead of print] PubMed PMID: 22578685Google Scholar
  80. 80.
    Casselman FP, Van Slycke S, Dom H, Lambrechts DL, Vermeulen Y, Vanermen H (2003) Endoscopic mitral valve repair: feasible, reproducible, and durable. J Thorac Cardiovasc Surg 125(2):273–282PubMedCrossRefGoogle Scholar
  81. 81.
    Murzi M, Solinas M, Bevilacqua S, Gasbarri T, Glauber M, Cerillo AG (2009) A new left atrial retractor for minimally invasive mitral valve surgery. J Card Surg 24(2):175–177PubMedCrossRefGoogle Scholar
  82. 82.
    Ricci D, Pellegrini C, Aiello M, Alloni A, Cattadori B, D’Armini AM, Rinaldi M, Viganò M (2010) Port-access surgery as elective approach for mitral valve operation in re-do procedures. Eur J Cardiothorac Surg 37(4):920–925PubMedCrossRefGoogle Scholar
  83. 83.
    Mihaljevic T, Cohn LH, Unic D, Aranki SF, Couper GS, Byrne JG (2004) One thousand minimally invasive valve operations: early and late results. Ann Surg 240(3):529–534; discussion 534PubMedCrossRefGoogle Scholar
  84. 84.
    Seeburger J, Borger MA, Falk V, Passage J, Walther T, Doll N, Mohr FW (2009) Minimally invasive mitral valve surgery after previous sternotomy: experience in 181 patients. Ann Thorac Surg 87(3):709–714PubMedCrossRefGoogle Scholar
  85. 85.
    Bolotin G, Kypson AP, Reade CC, Chu VF, Freund WL Jr, Nifong LW, Chitwood WR Jr (2004) Should a video-assisted mini-thoracotomy be the approach of choice for reoperative mitral valve surgery? J Heart Valve Dis 13(2):155–158; discussion 158PubMedGoogle Scholar
  86. 86.
    Sharony R, Grossi EA, Saunders PC, Schwartz CF, Ursomanno P, Ribakove GH, Galloway AC, Colvin SB (2006) Minimally invasive reoperative isolated valve surgery: early and mid-term results. J Card Surg 21(3):240–244PubMedCrossRefGoogle Scholar
  87. 87.
    Karimov JH, Piagneri V, Murzi M, Latsuzbaia K, Tiwari K, Cerillo AG, Solinas M, Glauber M (2010) Multiple recurrent periprosthetic leak after a mitral valve replacement in a 30-year-old man. J Cardiovasc Med (Hagerstown) 11(4):288–290CrossRefGoogle Scholar
  88. 88.
    Onnasch JF, Schneider F, Falk V, Walther T, Gummert J, Mohr FW (2002) Minimally invasive approach for redo mitral valve surgery: a true benefit for the patient. J Card Surg 17(1):14–19PubMedCrossRefGoogle Scholar
  89. 89.
    Iribarne A, Easterwood R, Russo MJ, Chan EY, Smith CR, Argenziano M (2012) Comparative effectiveness of minimally invasive versus traditional sternotomy mitral valve surgery in elderly patients. J Thorac Cardiovasc Surg 143(4 Suppl):S86–S90PubMedCrossRefGoogle Scholar
  90. 90.
    Burfeind WR, Glower DD, Davis RD, Landolfo KP, Lowe JE, Wolfe WG (2002) Mitral surgery after prior cardiac operation: port-access versus sternotomy or thoracotomy. Ann Thorac Surg 74(4):S1323–S1325PubMedCrossRefGoogle Scholar
  91. 91.
    Arcidi JM Jr, Rodriguez E, Elbeery JR, Nifong LW, Efird JT, Chitwood WR Jr (2012) Fifteen-year experience with minimally invasive approach for reoperations involving the mitral valve. J Thorac Cardiovasc Surg 143(5):1062–1068PubMedCrossRefGoogle Scholar
  92. 92.
    Murzi M, Solinas M, Glauber M (2009) Is a minimally invasive approach for re-operative mitral valve surgery superior to standard resternotomy? Interact Cardiovasc Thorac Surg 9(2):327–332PubMedCrossRefGoogle Scholar
  93. 93.
    Mohr FW, Onnasch JF, Falk V, Walther T, Diegeler A, Krakor R, Schneider F, Autschbach R (1999) The evolution of minimally invasive valve surgery – 2 year experience. Eur J Cardiothorac Surg 15(3):233–238; discussion 238–239PubMedCrossRefGoogle Scholar
  94. 94.
    Grossi EA, Loulmet DF, Schwartz CF, Ursomanno P, Zias EA, Dellis SL, Galloway AC (2012) Evolution of operative techniques and perfusion strategies for minimally invasive mitral valve repair. J Thorac Cardiovasc Surg 143(4 Suppl):S68–S70PubMedCrossRefGoogle Scholar
  95. 95.
    Noiseux N, Ruel M, Hemmerling TM (2008) Minimally invasive cardiac surgery: new challenges for the surgeon and the anesthesiologist. Tech Reg Anesth Pain Manag 12:72–79CrossRefGoogle Scholar
  96. 96.
    Aybek T, Doss M, Abdel-Rahman U, Simon A, Miskovic A, Risteski PS, Dogan S, Moritz A (2005) Echocardiographic assessment in minimally invasive mitral valve surgery. Med Sci Monit 11(4):MT27–MT32PubMedGoogle Scholar
  97. 97.
    Passage J, Seeburger J, Doll N, Czesla M, Walther T, Falk V, Mohr FW (2010) Minimally invasive mitral valve surgery in octogenarians. Heart Lung Circ 19:503CrossRefGoogle Scholar
  98. 98.
    Gillinov AM, Banbury MK, Cosgrove DM (2000) Hemisternotomy approach for aortic and mitral valve surgery. J Card Surg 15(1):15–20PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  1. 1.Department of Cardiothoracic SurgeryHeart Hospital, “G. Monasterio” Tuscany Foundation for Research and HealthMassaItaly

Personalised recommendations