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Mitral Valve Surgery

Minimally invasive mitral valve (MV) repair is a surgical technique that involves making small incisions in the chest to access the heart and repair the MV. However, there are certain contraindications to this procedure that must be considered to avoid unnecessary complications and emergency conversion to full sternotomy[2][3]. Some of the contraindications to minimally invasive MV repair include:

  • Severe aorto-iliac atherosclerosis: This condition can increase the risk of functional perioperative complications and is a contraindication for MIMVS[2].
  • Severe mitral annulus calcification: This condition can make mitral valve repair difficult and valve replacement hazardous from the risk of atrioventricular rupture[6].
  • Moderate to severe aortic regurgitation: This condition is a contraindication for minimally invasive MV surgery[3].
  • Significant bleeding disorders: Patients with significant bleeding disorders are not good candidates for minimally invasive MV repair[3].
  • Severe liver dysfunction: Patients with severe liver dysfunction are not good candidates for minimally invasive MV repair[3].
  • Symptomatic cerebrovascular disease or recent stroke: Patients with symptomatic cerebrovascular disease or recent stroke are not good candidates for minimally invasive MV repair[3].
  • Fixed pulmonary hypertension (>60 mmHg): This condition is a contraindication for minimally invasive MV surgery[3].
  • Significant aortic root dilatation: This condition is a contraindication for minimally invasive MV surgery[3].
  • Previous right thoracotomy: Patients who have had a previous right thoracotomy are not good candidates for minimally invasive MV repair[3].
  • Calcification of the aortic root or mitral annulus: This condition can make mitral valve repair difficult and valve replacement hazardous from the risk of atrioventricular rupture[3].
  • Right ventricular dysfunction: This condition is a contraindication for minimally invasive MV surgery[3].
  • Minor dilatation of the ascending aorta: This condition is not a contraindication for minimally invasive MV surgery[2].
  • Need for combined surgical procedures: Need for combined surgical procedures, such as tricuspid repair, cryo- or radiofrequency ablation of atrial fibrillation, and atrial septal defect repair, is not a contraindication for minimally invasive MV repair, although such procedures need additional time[2].

In summary, there are several contraindications to minimally invasive MV repair, including severe aorto-iliac atherosclerosis, severe mitral annulus calcification, moderate to severe aortic regurgitation, significant bleeding disorders, severe liver dysfunction, symptomatic cerebrovascular disease or recent stroke, fixed pulmonary hypertension, significant aortic root dilatation, previous right thoracotomy, calcification of the aortic root or mitral annulus, and right ventricular dysfunction.

Citations:
[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3857042/
[2] https://jovs.amegroups.org/article/view/23159/html
[3] https://www.ncbi.nlm.nih.gov/books/NBK567730/
[4] https://jovs.amegroups.org/article/viewFile/23159/pdf
[5] https://journal.hsforum.com/index.php/HSF/article/view/889
[6] https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-8/Limits-to-surgery-in-mitral-valve-disease