Minimally Invasive Mitral Valve Surgery Using A Safe And Effective New Left Atrial Exposure Device
Sara Volpi1, Vinci Naruka1, Bonnie Kyle1, Chris Oscier1, Ulrich Franke2, Magdalena Rufa2, Dincer Aktuerk1.
1St Bartholomew's Hospital, Barts Heart Center, London (UK), London, United Kingdom, 2Department of Cardiovascular Surgery, Robert-Bosch Hospital, Stuttgart, Germany.
BACKGROUND: Minimally invasive mitral surgery (MIMS) is being increasingly adopted worldwide. Pivotal to the safe conduct of the procedure is optimal visualization to allow detailed valve analysis and assessment of repairability. Positioning of conventional transthoracic left atrial retractors used during MIMS may be time-consuming and can result in limited view or thoracic bleeding. The aim of this study is to evaluate the safety and efficacy of an innovative self-expandable left atrial retractor during MIMS.METHODS: All patients underwent endoscopic MIMS via a right mini-thoracotomy using a self-expandable, fast-deployment left atrial retractor device (figure 1). A retrospective analysis of 245 patients at two mitral specialist centres was performed from January 2017 to July 2022. Every patient requiring isolated or concomitant mitral valve repair or replacement was included in the study.RESULTS: There were 129 female (53%) and 116 male (47%) patients with a mean age of 67 ± 10 years, mean body max index of 26 ± 5, and logistic EuroSCORE of 4.5 ± 4.0. Aetiology of the mitral valve pathology was stenosis in 11% (n=27), regurgitation in 80% (n=196), and mixed in 9% (n= 22) of patients. The device was used for both mitral valve repair (n=125) and replacement (n=120). Mean cardiopulmonary bypass time and cross-clamp were 171.2 ± 50.1 and 99.8 ± 30.0 respectively. Forty-nine patients received concomitant tricuspid valve repair, 104 underwent concomitant surgical ablation, and 73 patients had their left atrial appendage excluded. There were no cases of tissue damage, dislodgement, or migration of the left atrial retractor device. The incidence of postoperative cerebrovascular accident was 3.2% (n=8) and permanent peacemaker rate was 8.1% (n=20). 30-day mortality was 1.2% (n=3). The postoperative transthoracic echocardiogram for patients who underwent repair showed no or trivial mitral regurgitation in 90% (n= 220) of patients. None of the patients who underwent mitral valve replacement was found to have significant paravalvular leakage.CONCLUSIONS: The self-expandable left atrial retractor device allows excellent and safe exposure of the mitral valve with fast deployment and removal during MIMS. The use of this innovative retractor may represent a helpful alternative to conventional left atrial retractors. LEGEND: self-expandable left atrial retractor 
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