Minimally invasive mitral valve surgery: the subxiphoid approach

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Valvular Heart Disease

Background:

• Mitral valve replacement (MVR) is a critical procedure for valvular heart disease.
• Minimally invasive surgical approaches aim to reduce patient morbidity.
• The subxiphoid approach offers a unique alternative to conventional sternotomy.

Purpose of the Study:

• To describe a unique subxiphoid approach for mitral valve replacement.
• To compare operative and echocardiographic outcomes of the subxiphoid approach with traditional sternotomy and superior ministernotomy techniques.

Main Methods:

• Retrospective comparison of 54 patients undergoing MVR via subxiphoid approach (group 1) with 11 patients via superior ministernotomy (group 2) and 29 patients via full median sternotomy (group 3).
• Data collected included operative times, postoperative drainage, pain assessment, and echocardiographic findings.
• New York Heart Association (NYHA) functional class was assessed postoperatively.

Main Results:

• No operative mortality observed across all groups.
• Group 1 (subxiphoid) and group 3 (sternotomy) had significantly shorter operation times than group 2 (superior ministernotomy).
• Groups 1 and 2 showed significantly lower postoperative mediastinal drainage compared to group 3. Early echocardiographic results and NYHA functional class were similar across all groups.

Conclusions:

• The subxiphoid approach is a reliable method for mitral valve replacement, with documented echocardiographic efficacy.
• While not demonstrating prominent superiority over ministernotomy, the subxiphoid approach is a viable option for various mitral valve procedures.