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Surgical approaches to the mitral valve: variable paths to the same destination

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Surgical exposure to access mitral valve has been performed through various chambers in the heart like left atrium, right atrium and trans septal approach, through ascending aorta and left ventricle as well. Depending upon the surgical pathology, body habitus of the patient, and previous cardiac surgery, each approach has some advantages and disadvantages. This article reviews all the approaches and the surgical indications as well the advantages and disadvantages of the each approach.

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Author information

Authors and Affiliations

  1. 5200 Center Ave, Suite 715, Pittsburgh, PA, 15232, USA

    Ibrahim Sultan

  2. Department of Cardiothoracic Surgery, Kaiser Permanente, Los Angeles Medical Center, 1526 N. Edgemont Street, Los Angeles, CA, 90027, USA

    Dhaval Pravin Trivedi

  3. University of Pittsburgh Medical Center, 534 Squaw Run Road East, Pittsburgh, PA, 15238, USA

    Venkata Ratnam Machiraju

Authors
  1. Ibrahim Sultan
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  2. Dhaval Pravin Trivedi
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  3. Venkata Ratnam Machiraju
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Corresponding author

Correspondence to Venkata Ratnam Machiraju.

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This article does not contain any human/animal studies by any of the authors.

Conflict of interest

The authors declare that they have no conflict of interest.

Appendix

Appendix

Key references

Dome approach:

  1. 1.

    Pezella AT, Utley JR, Vander Salm TJ. Operative approaches to the left atrium and mitral valve: an update. Operative Tech Thorac Cardiovasc Surg.1998:3:74-94

  2. 2.

    Little S, Flynn M, Paterson GB, Gillinov AM, Blackstone EH. Revisiting the dome approach for partial sternotomy / minimally invasive mitral valve surgery, Ann Thorac Surg. 2009;87:694-7

Trans septal approach to the mitral valve:

  1. 3.

    Guiraudon GM, Ofiesh JG, Kaushik R. Extended vertical transatrial septal approach to the mitral valve. Ann Thorac Surg.1991;52:1058-1062

  2. 4.

    Deloche A, Acar C, Jebara V, Fabiani J-N, Carpentier A. Biatrial transseptal approach in case of difficult exposure to the mitral valve. Ann Thorac Surg. 1990;50:318-9

Trans Aortic mitral valve approach:

  1. 5.

    Goldstone AB, Woo YJ. Alternative approaches for mitral valve repair. Ann Cardiothorac Surg.2015 ;4: 469-473

  2. 6.

    Mihos CG, Sanatana O, Lamelas J. Intermediate results of transaortic edge-to-edge repair of the mitral valve in patients undergoing aortic valve replacement. J Heart Valve Dis. 2014; 23:91-6

Mitral valve approach through left thoracotomy:

  1. 7.

    Clowes GHA, Neville WE, Sancetta SM, Traks E, Lim K, Barwinsky J, Del Guercio LRM. Results of open surgical correction of Mitral valvular insufficiency and description of technique for approach from left side. Surgery.1962;51:138-154

  2. 8.

    Saunders PC, Grossi EA, Sharony R, et al. Minimally invasive technology for mitral valve surgery via left thoracotomy: experience with forty cases. J Thorac Cardiovasc Surg. 2004;127:1026-1032

  3. 9.

    Suzuki Y, Pagani FD, Bolling SF. Left thoracotomy for multiple-time redo mitral valve surgery using on-pump beating heart technique. Ann Thorac Surg. 2008 ; 86: 466-471

Mitral valve approach through right thoracotomy

  1. 10.

    Chitwood WR. Video assisted Mitral valve surgery: using Chitwood clamp. Operative Tech Thorac Cardiovasc Surg. 2000;5:190-202

  2. 11.

    Ward AF, Grossi EA , Galloway AC. Minimally invasive mitral valve surgery through right minithoracotomy under direct vision, J Thorac Dis. 2013;5:S673-S679

Beating Heart Mitral Valve surgery:

  1. 12.

    Romano MA, Haft JW, Pagani FD, Boling SF. Beating heart surgery via right thoracotomy for preoperative mitral valve surgery: A safe and effective operative alternative. J Thorac Cardiovasc Surg.2012;144:334-339

  2. 13.

    Thompson MJ, Behranwala A, Campanella C, Walker WS, Cameron EW. Immediate and long- term results of mitral prosthetic replacement using a right thoracotomy beating heart technique. Eur J Cardiothorac Surg.2003;24:47-51

Mitral valve surgery through left ventricle:

  1. 14.

    Woo YJ, McCormick RC. Transventricular mitral valve operations, The Ann Thorac Surg. 2011;92:1501-1503

  2. 15.

    Kaczorowski DJ, Blank M, Woo YJ. Intracardiac exposure for transventricular mitral valve ring annuloplasty repair during Dor ventriculoplasty.J Heart Lung Transplant.2012;31:1236-1238

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Sultan, I., Trivedi, D.P. & Machiraju, V.R. Surgical approaches to the mitral valve: variable paths to the same destination. Indian J Thorac Cardiovasc Surg 34 (Suppl 2), 105–112 (2018). https://doi.org/10.1007/s12055-017-0598-7

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  • DOI: https://doi.org/10.1007/s12055-017-0598-7

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