MINIMALLY INVASIVE VALVE SURGERY

Minimally invasive surgical techniques have proliferated at a staggeri ng rate in the last decade. Cardiac surgery has been a late entrant in this process but is currently experiencing a surge of interest in and techniques for minimally invasive approaches. Cardiac valve surgery h as seen a rapid and ongoing evolution of minimally invasive approaches that, it is hoped, will decrease patient discomfort, operative morbid ity, length of hospitalization, and cost, improve cosmetic healing, an d facilitate return to normal function while not compromising short-or long-term outcomes of the surgical procedure. This article examines t he evolution of recent experience with minimally invasive valve surger y and emphasizes the surgical considerations surrounding 1) the choice of incision, 2) access techniques for cardiopulmonary bypass (CPB), 3 ) methods of myocardial protection, 4) techniques for aortic occlusion , and 5) atrial incisions for exposure of the mitral valve. The result s of early and currently available series are also reviewed. (C) 1998 Rapid Science Publishers.