Step-by-step guide for endoscopic mitral valve surgery

Minimally invasive mitral valve surgery (MIMVS) is becoming the new standard for mitral valve (MV) operations and has shown to be safe and effective, with less morbidity compared to conventional sternotomy, despite longer cardiopulmonary bypass (CPB) and cross-clamp time. In the current era patients prefer smaller incisions and a shorter rehabilitation period. MV surgery through a limited incision requires a different mind-set due to its high complexity and steep learning curve, especially in a fully endoscopic approach. To achieve success with MIMVS, several new technical skills must be acquired and a steep learning curve must be overcome. We describe several techniques used in fully endoscopic MV repair and provide a step-by-step guide to set up and start a MIMVS program.