Minimally invasive mitral valve repair

Meanwhile mitral valve insufficiency is probably the second most common heart valve disease represented in cardiac surgery. Due to low perioperative morbidity and mortality, nowadays mitral valve repair can even be considered in asymptomatic patients. The enhancements of minimally invasive surgical techniques led to a decrease in surgical trauma and accelerated postoperative recovery, resulting in increased acceptance of these operating techniques. Therefore, the present review focuses on the different surgical access ways to the mitral valve and their significance for mitral valve repair.

The emergence of transcatheter approaches to mitral valve repair has focused attention on outcomes after surgical mitral valve repair. Results from the EVEREST II trial demonstrated worse short-term major adverse event rates for surgical repair. Recently, several studies were published analyzing contemporary outcomes, morbidity, mortality, and quality of life after conventional and minimally invasive surgical mitral valve repair to establish benchmarks for future therapeutic comparisons.

Today mitral valve repair is the gold standard for treatment of significant mitral valve regurgitation with low perioperative morbidity and mortality and excellent long-term results. It can be performed through minimally invasive surgical techniques without compromising long-term durability of repair results, but with a decrease in surgical trauma and accelerated postoperative recovery. Currently, endovascular therapy for mitral regurgitation (e.g., the MitraClip procedure) should be limited to patients who otherwise would not be eligible for surgery.