Volpi Sara, Eldin Joy, Kyle Bonnie, Savvatis Kostas, Guttmann Oliver, Nagib Ragi, Ahad Samir, Franke Ulrich, Rufa Magdalena, Aktuerk Dincer
Department of Cardiothoracic Surgery, Barts Heart Centre, London, UK.
Department of Perioperative Medicine, Barts Heart Centre, London, UK.
Innovations (Phila). 2025 Jul-Aug;20(4):391-396. doi: 10.1177/15569845251348195. Epub 2025 Jun 14.
Minimally invasive mitral valve surgery (MIMVS) is being increasingly adopted worldwide. Pivotal to the safe conduct of the procedure is optimal visualization to allow detailed valve analysis and assessment of reparability. Positioning of conventional transthoracic left atrial retractors used during MIMVS may be time-consuming and can result in a limited view or thoracic bleeding. The aim of this study was to evaluate the safety and efficacy of the FlexCrown™ retractor by Geister (Tuttlingen, Germany), an innovative self-expandable left atrial retractor, during MIMVS.
A retrospective analysis was performed of 245 patients at 2 mitral specialist centers from January 2017 to July 2022. All patients underwent MIMVS via a right minianterolateral thoracotomy using the FlexCrown retractor.
There were 129 female (53%) and 116 male (47%) patients with a mean age of 67 ± 10 years. The etiology of the mitral valve pathology was stenosis in 11% of patients ( = 27), regurgitation in 80% ( = 196), and mixed in 9% ( = 22). The device was used for both mitral valve repair ( = 125) and replacement ( = 120). There were no cases of tissue damage, dislodgement, or migration of the FlexCrown retractor. The postoperative transthoracic echocardiogram showed no or trivial mitral regurgitation in 90% of patients ( = 220).
The FlexCrown self-expandable left atrial retractor by Geister allows excellent and safe exposure of the mitral valve with fast deployment and removal during MIMVS. The use of this innovative retractor may represent a helpful alternative to conventional left atrial retractors.
微创二尖瓣手术（MIMVS）在全球范围内的应用日益广泛。该手术安全实施的关键在于实现最佳可视化，以便对瓣膜进行详细分析并评估可修复性。MIMVS过程中使用的传统经胸左心房牵开器的定位可能耗时，并且可能导致视野受限或胸腔出血。本研究的目的是评估德国图特林根的盖斯特公司生产的创新型自膨胀左心房牵开器FlexCrown™在MIMVS中的安全性和有效性。
对2017年1月至2022年7月期间2个二尖瓣专科中心的245例患者进行回顾性分析。所有患者均通过右前外侧小切口开胸，使用FlexCrown牵开器进行MIMVS。
患者中女性129例（53%），男性116例（47%），平均年龄67±10岁。二尖瓣病变的病因中，11%（n = 27）为狭窄，80%（n = 196）为反流，9%（n = 22）为混合性病变。该装置用于二尖瓣修复（n = 125）和置换（n = 120）。没有FlexCrown牵开器发生组织损伤、移位或迁移的情况。术后经胸超声心动图显示，90%（n = 220）的患者无或仅有微量二尖瓣反流。
盖斯特公司的FlexCrown自膨胀左心房牵开器在MIMVS中能够快速展开和移除，实现对二尖瓣的良好且安全的暴露。使用这种创新型牵开器可能是传统左心房牵开器的一个有益替代方案。
