الفهرس 
Anatomy of Mitral ValveOnly 14 pages are availabe for public view
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Abstract
Cardiac valve surgery operations have historically
been performed via a standard median sternotomy and
CPB. With the advent of minimally invasive surgery;
several new observations regarding the treatment of
patients with isolated valve disease have arisen.
Over the last decade there has been transformation in
the way cardiac surgeons, cardiologists, and patients decide
the approach to cardiac therapies. Patients now demand
less-invasive procedures with equivalent safety, efficacy,
and durability. Any form of new technology must provide
better outcome and have better efficiency in terms of safety
and durability. If scientific evidence shows that mini-VS
results in lower complication rates, surgeons must be
trained in these newer techniques. However, with different
training backgrounds, patient populations, and surgical
approaches, surgeons should use the technique that they
believe will result in the best outcome and with which they
feel most comfortable. The recent STS data shows that
11.3% of isolated mitral valve repairs are performed with
robotic assistance. Up to 20% surgeons are using some
minimally invasive methods for their repairs.
Critically appraising the results of MIMVS has
several limitations, based on the paucity of randomized controlled trials and the reliance on single center case series
or few other review papers. Furthermore, the definition of
―minimally invasive‖ is controversial. The STS defines
minimally invasive surgery as any procedure not performed
with a full sternotomy and CPB; however, this definition
does not really fit into valve surgery.
The studies reviewed in MIMVR do not show a
significant difference in operative mortality between
minimally invasive and conventional approaches.
Moreover, the long-term outcomes of these procedures
appear to be as durable as the conventional approaches
(with follow-up of up to 8 years).
There has been almost no doubt that these procedures
reduce the length of hospital stay and blood transfusion
while at the same time being cosmetically more attractive
than the conventional approach.
One of the major areas for further research is in the
field of neurological outcomes as there has been conflicting
data with a wide variation in the reported incidence of
stroke. Most of the published series continue to implicate
MIMVS done on the beating heart as increasing the risk of
perioperative stroke. Further disadvantages with MIMVS
are related to the use of femoral cannulation and perfusion,
with groin complications (e.g., infections and arterial dissections/ haematoma) accounting for morbidity unseen
with conventional sternotomy.
As for the future, minimally invasive cardiac surgery
is likely to become more widely adopted as growth in this
niche market and cardiac surgery as a whole is often
patient-driven, much in the same way that percutaneous
intervention for multivessel disease has been. In essence,
patients do not want a sternotomy and it is important as a
surgical community that we realize this. However, despite
enthusiasm, caution cannot be overemphasized as
traditional cardiac operations still enjoy proven long-term
success and ever-decreasing morbidity and mortality and
remain our benchmark measures for comparison. To pave
the path towards totally endoscopic valve surgery,
surgeons, cardiologists, and engineers must focus on
improving the methods of computerization of the
instruments.
Patient requirements, technology development, and
surgeon capabilities all must be aligned to drive these
needed changes. Minimally invasive valve surgery is an
evolutionary process, and there must be a well-balanced
alignment between the surgeons and the cardiologists to
derive the maximal benefit that this technology has to offer.
Traditional valve operations enjoy proven long-term
success with ever-decreasing morbidity and mortality and remain the gold standard. Minimally invasive surgeries are
probably not going to replace the gold standard, but they
should present themselves as an alternative for treatment of
mitral valve diseases with equal long-term durability.