Planning minimally invasive mitral valve surgery

Minimally invasive mitral valve surgery (MIMVS) has still not been widely adopted as standard approach for surgical treatment of mitral valve disease due to a lack of consistent supporting evidence. Several studies have demonstrated MIMVS to be associated with shorter hospitalization stay, less bleeding and less wound infections, in spite of increased risk of stroke and longer operating times. In our philosophy, these complications can be reduced by use of precise patient selection and extensive preoperative planning. The current review aims to present an overview of current literature on this topic together with our institutions experience in this field. Advanced application of echocardiography and computed tomography (CT) with three-dimensional anatomical reconstruction could lead to an exclusion of high-risk patients for MIMVS, resulting in a reduction of complications and leading to potential superiority of this procedure compared to conventional surgery. With emergence of trans-catheter and surgical off-pump mitral valve procedures, echocardiography will play an increasingly important role, as these operations require echo-guidance. Due to technological advancements in the field of CT, we foresee this imaging modality to become more widely accepted and available, facilitating a more precise assessment of cardiac function and valvular pathology.