A new left atrial retractor for minimally invasive mitral valve surgery

The recent boost of the minimally invasive techniques for mitral valve surgery has led to the development of a dedicated surgical outfit, including retractors, arterial and venous cannulas, and surgical instruments. An effective left atrial retractor is crucial, since an optimal exposure is a prerequisite for a successful mitral valve repair. Most of the available retractors require a supporting arm that is inserted in the chest via a parasternal hole. This maneuver may be associated with significant bleeding from the internal thoracic artery and vein or from their collaterals, especially in patients undergoing redo operations in whom the identification of these vessels may be difficult. The MitraXs is a self-expanding, pliable, left atrial retractor that may be inserted in the atrium from the minithoracotomy, and does not require any supporting arm. We describe its use in a patient with a previous history of esophageal resection and retrosternal colon interposition.

The mitral valve was approached via right minithoracotomy with femoral bypass and direct aortic cross-clamping. In this particular case, the MitraXs was used to avoid the blunt insertion of the conventional retractor's supporting arm in order to prevent any possible injury to the neo-esophagus.The mitral valve exposure was excellent, and the operation was easily performed. The postoperative course was uneventful.

In our opinion, the described approach allows a safe exposure of the aorta and left atrium, and should be considered the approach of choice in patients with retrosternal anomalies. The use of the MitraXs retractor may represent a helpful addition in selected patients, and should be recommended for redo operations.