What s new in mitral valve surgery

Technical developments are rich in this field towards the less invasive :At the first time the surgical approach was changed for avoiding sternotomy (mini-thoracotomy with video-assistance).Conventional surgery and minithoracotomy surgery have been compared in large prospective trials and Meta-analyzes. Although the duration of operation and the time of CPB are longer for minimally invasive techniques, bleeding and therefore transfusion requirements and length of stay in intensive care are reduced.Early results at 30 days in terms of quality of repair (> 99% of MI grade 0 or 1), 30-day mortality (1.4%) and stroke incidence (1.7%) are identical to those of conventional surgery. The long-term results in terms of mortality and functional results are also similar. In experienced teams, mini invasive surgery becomes superior in terms of esthetic result, postoperative comfort (less pain and length of stay, better functional recovery,) and with a decrease in overall costs, so these techniques are now validated and done routinely in high volume centers.Conventional and minimally invasive surgeries despite their excellent results require extracorporeal circulation and aortic cross-clamping.Innovative techniques are now trying to correct valvulopathies, in beating heart, by reproducing the same technics used in conventional open surgery, by 3D ultrasound guidance. Mitral clip, Trans apical neocordages and percutaneous annuloplasty are the examples of these percutaneous innovations The development of these techniques is in progress and supported by many start-ups.At the same time the implantation of percutaneous mitral prostheses is in Progress too but the mitral anatomy, more complex, limits the implantations. To date, percutaneous valve replacement procedures remain sporadic and in the context of preliminary clinical trials (less than a dozen patients for each new prosthesis).The combination of different percutaneous techniques will probably in future treat a large number of mitral valve diseases. However, the way seems long.