Minimally invasive mitral valve reconstruction on the fibrillating heart for high-risk patients

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Cardiac Surgery
• Mitral Valve Repair

Background:

• Reoperative mitral valve surgery is technically challenging and carries significant risks.
• Previous coronary artery bypass grafting (CABG) increases the risk of graft injury and myocardial ischemia during mitral valve surgery.
• Existing aortic valve prostheses and porcelain aorta can further complicate surgical access and patient selection.

Purpose of the Study:

• To evaluate the safety and efficacy of minimally invasive mitral valve repair in high-risk patients with prior cardiac surgery.
• To assess the feasibility of this approach in patients with specific complicating factors such as previous CABG, aortic valve prostheses, or porcelain aorta.

Main Methods:

• A series of 10 patients underwent minimally invasive mitral valve repair.
• The procedure utilized a right-sided anterolateral minithoracotomy without aortic cross-clamping on a fibrillating heart.
• Vascular access was achieved via femoral or axillary artery cannulation.

Main Results:

• Successful mitral valve reconstruction was achieved in nine out of 10 patients.
• No perioperative mortality was observed.
• While one patient required re-exploration for bleeding and another experienced lower-limb ischemia, the remaining eight patients had uneventful postoperative courses. No significant residual mitral insufficiency was detected on echocardiography.

Conclusions:

• Minimally invasive mitral valve reconstruction via right-sided minithoracotomy is an effective surgical strategy for high-risk reoperative cases.
• This approach provides a valuable alternative for patients previously considered inoperable due to complex cardiac histories.