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Related Concept Videos

Mitral Valve Prolapse I: Introduction01:27

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IntroductionThe mitral valve, one of the heart's four valves, regulates blood flow. These valves have flaps that open and close to direct blood properly through the heart and body. During each heartbeat, the flaps open for blood to pass through and seal shut to prevent backflow. Specifically, the mitral valve opens to allow blood flow from the heart's upper left chamber to the lower left chamber. It then closes securely as the lower left chamber contracts to pump blood to the body, preventing...
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Mitral Valve Prolapse II: Assessment and Management01:22

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IntroductionA range of clinical features characterizes Mitral Valve Prolapse (MVP), but it is important to note that many individuals with MVP are asymptomatic and may remain so throughout their lives. For those who do exhibit symptoms, the following are the key clinical features:Palpitations: This is a common symptom where individuals feel an irregular or rapid heartbeat. Palpitations in MVP are often due to arrhythmias such as premature ventricular contractions or supraventricular...
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The nursing management of Mitral Valve Prolapse, or MVP, centers around patient education, symptom monitoring, and lifestyle modifications.Patient Education on MVP Diagnosis and Heredity: Nurses should provide comprehensive education about MVP, a condition where the mitral valve does not close appropriately during heartbeats. This education often includes the condition's pathophysiology, symptoms, and potential complications, like arrhythmias or mitral regurgitation. Though not fully...
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In statistics, several tools are used to interpret the data. Measures of central tendency represent the characteristics of the data, such as mean, median, and mode. Additionally, measures of variance like standard deviation and range are used to find the spread of data from the mean. Relative standing measures the distance between data locations. Commonly used measures of relative standings are percentile, z score, and quartiles.
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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Axillary Versus Sternotomy Access in Minimally Invasive Mitral Valve Surgery: A Systematic Review and Meta-Analysis.

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  • 1Department of Cardiovascular Science, University College London, UK.

Innovations (Philadelphia, Pa.)
|January 28, 2026
PubMed
Summary

Minimally invasive mitral valve surgery via axillary access shows similar mortality to median sternotomy. This approach offers fewer wound complications and faster recovery, despite longer cardiopulmonary bypass times.

Keywords:
axillary accessmedian sternotomyminimally invasive mitral valve surgery

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Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Techniques
  • Thoracic Surgery

Background:

  • Minimally invasive cardiac surgery (MICS) for mitral valve (MV) disease is increasingly adopted.
  • Axillary access is a MICS approach associated with potential benefits like reduced pain and faster recovery.
  • Comparative data on axillary access versus traditional median sternotomy for MV surgery (MVS) is limited.

Purpose of the Study:

  • To conduct a meta-analysis comparing clinical outcomes of MVS via axillary access and median sternotomy.
  • To evaluate perioperative mortality and secondary endpoints between the two surgical approaches.

Main Methods:

  • A systematic review and meta-analysis of four databases.
  • Inclusion of studies comparing axillary access and median sternotomy for MVS.
  • Primary endpoint: perioperative mortality. Secondary endpoints: cardiopulmonary bypass (CPB) and cross-clamp times, rethoracotomy, wound complications, ventilation duration, stroke, hospital and ICU stay, and residual mitral regurgitation.
  • Random-effects model utilized for analysis.

Main Results:

  • 2,129 patients from 4 studies were analyzed; 53.3% underwent axillary access.
  • Perioperative mortality was comparable between axillary access and median sternotomy (OR = 0.34, P = 0.10).
  • Axillary access was associated with longer CPB times (MD = 16.38 min, P = 0.001), fewer wound complications (OR = 0.41, P = 0.009), and shorter ventilation duration (MD = -4.93 min, P < 0.01).
  • Shorter hospital (MD = -0.78 days, P = 0.02) and ICU stays (MD = -10.84 days, P = 0.01) were observed with axillary access.
  • No significant differences in cross-clamp time, rethoracotomy, stroke, or residual mitral regurgitation.

Conclusions:

  • Axillary access for MVS demonstrates comparable perioperative mortality to median sternotomy.
  • Axillary access offers advantages in reduced wound complications and shorter recovery times (ventilation, hospital, and ICU stay).
  • Longer cardiopulmonary bypass times with axillary access require consideration; further research is needed for long-term safety and efficacy confirmation.