Decision Making during the Learning Curve of Minimally Invasive Mitral Valve Surgery: A Focused Review for the Starting Minimally Invasive Surgeon
Abstract
:1. Introduction
2. Learning Curve of Minimally Invasive Mitral Valve Surgery
3. Benefits and Limitations of Minimally Invasive Access
3.1. Benefits of Minimally Invasive Access
3.2. Limitations of Minimally Invasive Access
4. Considerations in Pre-Operative Planning and Patient Selection during the Learning Curve
4.1. Pre-Operative Planning and Imaging
4.2. Patient Selection
4.3. Considerations of Mitral Valve Pathology during Learning Curve of MIMVS
5. Available Techniques and Safety Considerations
5.1. Safety of the Minimally Invasive Techniques
5.2. Less Invasive Surgical Access and Visualization of the Mitral Valve
5.3. Cardiopulmonary Bypass: Arterial Cannulation
5.4. Cardiopulmonary Bypass: Venous Cannulation
5.5. Techniques for Aortic Occlusion and De-Airing
5.6. Hypothermic Fibrillary Arrest
5.7. Valve Repair and Replacement Techniques
6. Conversion to Sternotomy
7. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Conflicts of Interest
References
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Significant Aortic, Iliac, or Femoral Disease That Prevents Safe Retrograde Arterial Perfusion |
---|
Left ventricular ejection fraction < 25% |
Severe right ventricular dysfunction |
Pulmonary artery pressure > 70 mmHg |
Aorta > 4 cm if endo-aortic balloon being used |
Significant mitral annular calcification |
Patients with more than mild aortic regurgitation |
Kyphoscoliosis and pectus excavatum |
Morbidly obese and extremely muscular patients |
Previous right thoracotomy or expected adhesions in the right chest |
Advanced renal- or liver disease, significant pulmonary disease |
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Ko, K.; Verhagen, A.F.T.M.; de Kroon, T.L.; Morshuis, W.J.; van Garsse, L.A.F.M. Decision Making during the Learning Curve of Minimally Invasive Mitral Valve Surgery: A Focused Review for the Starting Minimally Invasive Surgeon. J. Clin. Med. 2022, 11, 5993. https://doi.org/10.3390/jcm11205993
Ko K, Verhagen AFTM, de Kroon TL, Morshuis WJ, van Garsse LAFM. Decision Making during the Learning Curve of Minimally Invasive Mitral Valve Surgery: A Focused Review for the Starting Minimally Invasive Surgeon. Journal of Clinical Medicine. 2022; 11(20):5993. https://doi.org/10.3390/jcm11205993
Chicago/Turabian StyleKo, Kinsing, Ad F. T. M. Verhagen, Thom L. de Kroon, Wim J. Morshuis, and Leen A. F. M. van Garsse. 2022. "Decision Making during the Learning Curve of Minimally Invasive Mitral Valve Surgery: A Focused Review for the Starting Minimally Invasive Surgeon" Journal of Clinical Medicine 11, no. 20: 5993. https://doi.org/10.3390/jcm11205993
APA StyleKo, K., Verhagen, A. F. T. M., de Kroon, T. L., Morshuis, W. J., & van Garsse, L. A. F. M. (2022). Decision Making during the Learning Curve of Minimally Invasive Mitral Valve Surgery: A Focused Review for the Starting Minimally Invasive Surgeon. Journal of Clinical Medicine, 11(20), 5993. https://doi.org/10.3390/jcm11205993