An International Survey-Based Assessment of Minimally Invasive Mitral Valve Surgery

OBJECTIVES: Minimally invasive mitral valve surgery (MIMVS) has been shown to be safe and feasible however its adoption has lagged globally. The international consortium is lacking a set of guidelines that are specific to MIMVS. The aim of this study was to capture the practices of MIMVS in different centres. METHODS: A survey was constructed containing 52 multiple-choice and open-ended questions about various aspects of MIMVS. The survey was sent to centers that routinely and frequently perform MIMVS. All surgeons provided informed consent for participating in the survey and publication of data. RESULTS: The survey was sent to 75 known surgeons from whom 32 (42%) completed the survey. All survey responders performed more than 25 MIMVS cases annually. Twenty (68%) of the surgeons thought that simulation training, MIMVS fellowship, and proctorship are all essential prior to commencing a MIMVS program. Eleven (34%) of the surgeons stated that 50-100 MIMVS cases are required to overcome the learning curve, followed by 6 (18%) who said 21-30 cases should suffice. Eighteen (62%) of the surgeons had adopted a fully endoscopic approach for their MIMVS, followed by 15 (51%) surgeons who had performed cases via endoscopic-assisted strategies, 5 (17%) surgeons had conducted the operation under direct visualization, and 6 (20%) surgeons had used a robot for their MIMVS. CONCLUSIONS: The study highlights a marked variability on training and approach to MIMVS. Consensus guidelines should be established to allow standardisation of MIMVS.