Indications and contra-indications for minimally invasive mitral valve surgery

A minimally invasive access through right mini-thoracotomy (MT) for mitral valve surgery (MIMVS) is indicated in all cases except those which cannot be safely addressed by this approach, i.e., in particular major annular calcification (MAC). Other conditions to be regarded as contraindications generally either impose an increased risk of complications compared to the standard approach (e.g., severe aorto-iliac atherosclerosis) or may simply jeopardize the results of MIMVS (any co-morbidity imposing an elevated surgical risk). Partial sternotomy (PS) represents an alternative less invasive approach for cases when MT is not feasible including severe MAC, concomitant aortic valve replacement (AVR) and selected indications for coronary artery bypass graft (CABG). Full sternotomy may be reserved for multiple bypass grafting, use of left internal mammary artery (LIMA), right internal mammary artery (RIMA) and reoperations when a MT approach is not appealing.