Video-Assisted Minimally Invasive Mitral Valve Repair: Periareolar Approach

In the view of the authors, video-assisted minimally invasive mitral valve repair is associated with the same mortality as conventional sternotomy, but with less morbidity, fewer infections, a shorter hospital stay, and lower readmission rates. The periareolar approach yields superior cosmetic results without compromising exposure of the valve or the quality of the repair.

This is the case of a 54-year-old woman with A2 prolapse and severe, symptomatic mitral regurgitation. A 4.5 cm right periareolar incision was performed. The right femoral vessels were cannulated using a modified Seldinger technique and echo guidance. A Chitwood clamp was used and the heart was arrested using cold Del Nido cardioplegia. A 5 mm 30 degree lens was placed through the fourth interspace. Inspection of the valve showed A2 prolapse with severe annular dilatation. The valve was repaired by placing two neochordae to A2 and a 32 Edwards Physio Ring. Echocardiogram showed no residual mitral valve insufficiency, with a 9 mm height of coaptation.