Surgical technique of minimally invasive videoscopic MV surgery
(MIVT)
The MIVT program at our institution started in 2008, and has been
applied to all patients presenting for elective MV surgery since then.
Patients were omitted during the early phase of the program in case of
previous cardiac surgery, extensive annular calcifications and
precarious vascular access. Preoperative screening for MIVT
systematically included angiographic imaging of the complete aorta to
femoral vessels, to rule out severe atherosclerotic disease. Patients
were routinely intubated with a double-lumen endotracheal tube to allow
single lung ventilation. Surgical access was obtained through a right
anterior thoracotomy at the 4th intercostal space, via
a 5-6 cm skin incision. Cardiopulmonary bypass was installed through
cannulation of the femoral vein and artery via Seldinger technique, and
correct positioning of the cannulas under guidance of transesophageal
echocardiography. Cardioplegic arrest was achieved by antegrade
administration of cold crystalloid cardioplegia in the aortic root after
aortic clamping with Chitwood clamp or endoaortic balloon occlusion
(IntraClude, Edwards Lifesc., Irvine, CA, USA). MV repair was done
according to classical techniques.
MV surgery through sternotomy was used as standard approach before the
end of 2008, and was still used later on for patients requiring
concomitant procedures like aortic valve surgery or coronary artery
bypass grafting, patients with extensive mitral annular calcifications,
or those presenting with fulminant lung edema in need for preoperative
respiratory support, prohibiting single lung ventilation.