Video assisted minimally invasive mitral valve replacement in rheumatic valve disease.

  • Heba Abdel-Kareem Cardio-thoracic Surgery department, Assiut university,Egypt.
  • Mohammed Alaa Cardio-thoracic Surgery department, Assiut university,Egypt.
  • Mahmoud Khairy Assiut University
  • Ali Abdel-Wahab Cardio-thoracic Surgery department, Assiut university,Egypt.
  • Morsi Mohammed General Surgery department, Assiut university,Egypt.
Keywords: Video assisted, Minimally invasive, Rheumatic



Assessment early outcome of video assisted minimally invasive mitral valve replacement, in rheumatic valve disease. Also, to evaluate early postoperative quality of life by SF 36 questionnaire.

Methods: This is a prospective single center study which was conducted on 20 rheumatic heart patients, in Egypt; during the period from October 2015 to June 2018. The main pathological lesion was sever mitral regurgitation (MR), mitral stenosis (MS) or both. Patients underwent video assisted minimally invasive mitral valve replacement, through a right mini thoracotomy. 13 patients (65%) were via infra-mammary incision, 4 patients (20%) were via periareolar incision and 3 patients (15%) were via limited right anterolateral mini-thoracotomy.

Results: Mean length of surgical incision was (6.60 ± 1.35 cm). Mean duration of operation, cardiopulmonary bypass, and cross clamp times were (4.32 ± 1.08 hr.), (2.85 ± 0.75 hr.) and (1.78 ± 0.47 hr.) respectively.

ICU stay was 2.35 ± 1.14 days and Hospital stay was 6.45 ± 1.43 days.

The mean amount of blood loss was 398.50 ± 245.79 ml with two patients of bleeding requiring re-opening.

At discharge, all patients had normal mitral prosthetic valve function with no or trivial regurgitation, as shown by echocardiographic studies. The postoperative quality of life revealed faster recovery of usual activities.

Conclusions: Video assisted minimally invasive mitral valve surgery in the surgically challenging rheumatic valve disease has less surgical trauma, blood loss and pain, which translates into short hospital stay, rapid return to normal activities, less use of resources.



Navia JL, Cosgrove DM. Minimally invasive mitral valve operations. Ann Thorac Surg 1996; 62 (November (5)):1542-4.

Cohn LH, Adams DH, Couper GS, Bichell DP, Rosborough DM, Sears SP, Aranki SF. Minimally invasive cardiac valve surgery improves patient satisfaction while reducing costs of cardiac valve replacement and repair. Ann Surg 1997; 226(October (4)):421-6. Discussion 7-8.

Carpentier A, Loulmet D, Carpentier A, Le Bret E, Haugades B, Dassier P, Guibourt P. [Open heart operation under video surgery and minithoracotomy. First case (mitral valvuloplasty) operated with success]. Comptes rendus de l‘Academie des sciences 1996; 319 (March (3)):219-23.

Chitwood Jr WR, Elbeery JR, Moran JF. Minimally invasive mitral valve repair using transthoracic aortic occlusion. Ann Thorac Surg 1997; 63(May (5)):1477-9.

Chitwood Jr WR, Wixon CL, Elbeery JR, Moran JF, Chapman WH, Lust RM. Video-assisted minimally invasive mitral valve surgery. J Thorac Cardiovasc Surg 1997; 114 (November (5) : 773-80. Discussion 80-2.

Mohr FW, Falk V, Diegeler A, Walther T, van Son JA, Autschbach R. Minimally invasive port-access mitral valve surgery. J Thorac Cardiovasc Surg 1998; 115(March (3)):567-74. Discussion 74-6.

Falk V, Walther T, Autschbach R, Diegeler A, Battellini R, Mohr FW. Robot assisted minimally invasive solo mitral valve operation. J Thorac Cardiovasc Surg 1998; 115 (February (2)):470-1.

Soltesz EG, Cohn LH. Minimally invasive valve surgery. Cardiol Rev 2007; 15(May-June (3)):109-15.

John E. Ware, Jr., and Barbara Gandek, Overview of the SF-36 Health Survey and the International Quality of Life Assessment [IQOLA] Project J Clin Epidemiol 1998; Vol. 51, No. 11, pp. 903–912.

Gammie JS, Krowsoski LS, Brown JM, et al. Aortic valve bypass surgery: midterm clinical outcomes in a high-risk aortic stenosis population. Circulation 2008; 118:1460–6.

STS Database. Spring 2007 Executive Summary. Durham, NC: Duke Clinical Research Institute, 2007.

Jan D. Schmitto, MD, P, Suyog A. Mokashi, MD, Lawrence H. Cohn, Minimally-Invasive Valve Surgery Journal of the American College of Cardiology 2010; Vol. 56, No. 6.

Ryan WH, Dewey TM, Mack MJ, et al. Mitral valve surgery using the classical heart port ‘technique. J Heart Valve Dis 2005; 14:709 –14.

Mihaljevic T, Cohn LH, Unic D, Aranki SF, Couper GS, Byrne JG. One thousand minimally invasive valve operations: early and late results. Ann Surg 2004; 240:529 –34.

Asher CR, Dimengo JM, Arheart KL, et al. Atrial fibrillation early postoperatively following minimally invasive cardiac valvular surgery. Am J Cardiol 1999; 84:744 –749.

Murphy GJ, Reeves BC, Rogers CA, et al. Increased mortality, postoperative morbidity and cost after red blood cell transfusion in patients having cardiac surgery. Circulation 2007; 116:2544 –52.

Yamada T, Ochiai R, Takeda J, et al. Comparison of early postoperative quality-of-life in minimally invasive versus conventional valve surgery. J Anesth 2003; 17:171–17 6.

Dogan S, Aybek T, Risteski PS, et al. Minimally invasive port-access versus conventional mitral valve surgery: prospective randomized study. Ann Thorac Surg 2005; 79:492– 8.

Grossi EA, Galloway AC, Ribakove GH, et al. Impact of minimally invasive valvular heart surgery: a case-control study. Ann Thorac Surg 2001; 71:807–10.

Nifong LW, Chitwood WR, Pappas PS, et al. Robotic mitral valve surgery: a United States multicenter trial. J Thorac Cardiovasc Surg 2005; 129:1395– 404.

Seeburger J, Borger MA, Falk V, et al. Minimal invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients. EurJ Cardiothoracic Surg 2008; 34:760 –5.

Mattia Glauber, Antonio Miceli, Daniele Canarutto, Antonio Lio, Michele Murzi, Daniyar Gilmanov et al., Early and long-term outcomes of minimally invasive mitral valve surgery through right minithoracotomy: a 10-year experience in 1604 patients. Journal of Cardiothoracic Surgery 2015, 10:181.

Gaudiani VA, Grunkemeier GL, Castro LJ, et al. Mitral valve operations through standard and smaller incisions. Heart Surg Forum2004; 7:E337– 42.

Glower DD, Landolfo KP, Clements F, et al. Mitral valve operation via port access versus median sternotomy. Eur J Cardiothoracic Surg 1998; 14 Suppl1:143. [25] R. Scott McClure, Leonidas V. Athanasopoulos, Siobhan McGurk, Michael J. Davidson,, Gregory S. Couper, and Lawrence H. Cohn, One thousand minimally invasive mitral valve operations: Early outcomes, late outcomes, and echocardiographic follow-up, The Journal of Thoracic and Cardiovascular Surgery 2013; Volume 145.

Felger JE, Nifong LW, Chitwood WR Jr., et al. The evolution of and early experience with robot-assisted mitral valve surgery. Surg Laparosc Endosc Percutan Tech 2002; 12:58–63.

Casselman FP, Van Slycke S, Wellens F, et al. Mitral valve surgery can now routinely be performed endoscopically. Circulation 2003; 108 Suppl 1:II48 –54.

Chitwood WR, Wixon CL, Elbeery JR, et al. Video-assisted minimally invasive mitral valve surgery: micro-mitral‖ operation. J Thorac Cardiovascn Surg 1997; 113:413– 4.

Walther T, Falk V, Metz S, et al. Pain and quality-of-life after minimally invasive versus conventional cardiac surgery. Ann Thorac Surg 1999; 67:1643– 7.

Hunt SM, McKenna SP, McEwen J, Backett EM, Williams J, Papp E. A quantitative approach to perceived health status: a validation study. J Epidemiol Comm Health 1980; 34:281– 6.

How to Cite
Abdel-Kareem, H., Alaa , M., Khairy, M., Abdel-Wahab, A., & Mohammed, M. (2019). Video assisted minimally invasive mitral valve replacement in rheumatic valve disease. The Egyptian Cardiothoracic Surgeon, 1(1), 10 - 18.
Adult cardiac