Minimally Invasive Mitral Valve Repair (MIMVR) is a surgical approach to treat mitral valve dysfunction through smaller incisions, offering benefits like reduced recovery time, less pain, and decreased risk of infection compared to traditional open-heart surgery. Here's an overview of its indications and techniques:


Indications for Minimally Invasive Mitral Valve Repair:

  • Mitral Regurgitation (MR):

    • Primary MR: Due to degenerative changes in the valve leaflets or chordae tendineae, like mitral valve prolapse or flail leaflet.

    • Secondary MR: Resulting from left ventricular dysfunction or dilation, often associated with ischemic heart disease or cardiomyopathy.

  • Mitral Stenosis: Though less common for repair, some cases with mild to moderate stenosis might be amenable to repair rather than replacement.

  • Asymptomatic Patients: With severe MR, particularly if there's evidence of left ventricular dilation, pulmonary hypertension, or atrial fibrillation, indicating early intervention might be beneficial.

  • Symptomatic Patients: With signs of heart failure or reduced exercise capacity.

  • Patient Factors:

    • Good candidates are those without significant comorbidities or contraindications for minimally invasive approaches (like severe peripheral vascular disease).

    • Preference for those who can benefit from reduced surgical trauma, potentially including quicker return to activity.


Techniques for Minimally Invasive Mitral Valve Repair:

Surgical Access Methods:

  • Right Mini-Thoracotomy: A small incision on the right side of the chest between the ribs provides access to the mitral valve. This is the most common approach:

    • Direct Vision: Using long instruments, the surgeon operates with direct visualization of the valve.

    • Thoracoscopic Assistance: A camera might be used to enhance visualization, sometimes with additional small incisions for instruments.

  • Port-Access: A variation where surgery is performed through several small ports, with or without robotic assistance.

  • Robotic-Assisted Surgery: Involves even smaller incisions, with the surgeon operating from a console controlling robotic arms. This method offers high precision but requires significant setup and expertise.


Repair Techniques:

  • Annuloplasty: Placement of a ring around the valve annulus to reshape and support it, reducing the size of the valve opening to prevent regurgitation.

  • Leaflet Repair:

    • Leaflet Resection: Removing excess or prolapsing tissue.

    • Neochordae Placement: Using artificial chords (like PTFE sutures) to correct leaflet prolapse by attaching them to the papillary muscles and leaflets.

  • Edge-to-Edge Repair (Alfieri Technique): Suturing the edges of the two leaflets together at the point of regurgitation, creating a double-orifice valve effect.

  • Chordal Transfer: For cases where chordae are ruptured or too long, chordae from one part of the valve might be transferred to another.


Additional Considerations:

  • Cardiopulmonary Bypass (CPB): Typically required, with cannulation often through the femoral vessels or directly in the chest for central cannulation.

  • Myocardial Protection: Cardioplegia is delivered to stop the heart temporarily for surgery.

  • Postoperative Care: Includes echocardiography to confirm the repair's success and monitor for complications.


Minimally invasive techniques for mitral valve repair are increasingly adopted due to their benefits, but they require a surgeon with specialized training and experience. Patient selection is crucial, as not all mitral valve pathologies or patient conditions are suitable for these approaches. The choice between techniques also depends on the specific pathology of the mitral valve, patient anatomy, and the surgical team's expertise.