Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany;
Departmemnt of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA;
Ann Cardiothorac Surg. 2013 Nov;2(6):733-8. doi: 10.3978/j.issn.2225-319X.2013.11.11.
Minimally invasive mitral valve surgery (MIMVS) has become a standard technique to perform mitral valve surgery in many cardiac centers. However, there remains a question regarding when MIMVS should not be performed due to an increased surgical risk. Consequently, expert surgeons were surveyed regarding their opinions on patient factors, mitral valve pathology and surgical skills in MIMVS.
Surgeons experienced in MIMVS were identified through an electronic search of the literature. A link to an online survey platform was sent to all surgeons, as well as two follow-up reminders. Survey responses were then submitted to a central database and analyzed.
The survey was completed by 20 surgeons. Overall results were not uniform with regard to contraindications to performing MIMVS. Some respondents do not consider left atrial enlargement (95% of surgeons), complexity of surgery (75%), age (70%), aortic calcification (70%), EuroSCORE (60%), left ventricular ejection fraction (55%), or obesity (50%) to be contraindication to surgery. Ninety percent of respondents believe more than 20 cases are required to gain familiarity with the procedure, while 85% believe at least one MIMVS case needs to be performed per week to maintain proficiency. Eighty percent recommend establishment of multi-institutional databases and standardized surgical mentoring courses, while 75% believe MIMVS should be incorporated into current training programs for trainees.
These results suggest that MIMVS has been accepted as a treatment option for patients with mitral valve pathologies according the expert panel. Initial training and continuing practice is recommended to maintain proficiency, as well as further research and formalization of training programs.
微创二尖瓣手术（MIMVS）已成为许多心脏中心行二尖瓣手术的标准技术。然而，由于手术风险增加，仍存在不应行 MIMVS 的情况。因此，专家外科医生对患者因素、二尖瓣病变和 MIMVS 中的手术技能方面的意见进行了调查。
通过文献电子搜索确定有经验的 MIMVS 外科医生。向所有外科医生发送了一个在线调查平台的链接，并进行了两次后续提醒。然后将调查结果提交到中央数据库并进行分析。
共有 20 名外科医生完成了这项调查。对于是否应行 MIMVS 的禁忌证，总体结果并不一致。一些受访者不认为左心房增大（95%的外科医生）、手术复杂性（75%）、年龄（70%）、主动脉钙化（70%）、EuroSCORE（60%）、左心室射血分数（55%）或肥胖（50%）是手术禁忌证。90%的受访者认为需要超过 20 例手术才能熟悉该手术，而 85%的受访者认为每周至少需要行 1 例 MIMVS 手术才能保持熟练程度。80%的受访者建议建立多机构数据库和标准化手术指导课程，而 75%的受访者认为 MIMVS 应纳入目前的培训计划中。
这些结果表明，根据专家小组的意见，MIMVS 已被接受为治疗二尖瓣病变患者的一种选择。建议进行初始培训和持续实践以保持熟练程度，同时还需要进一步研究和规范培训计划。
