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.
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Dear Dr. Umana, really gratifying to see the periareolar approach being used more often. Since 2006 when we pioneered this access(1) and published in 2009(2) we have operated 214 patients, most of them females. We have being using this access not only for mitral valve but for tricuspid valve, ASD closure, AF ablation and pace maker leads extraction. It is our preferred access especially in women.
Best regards,
Robinson Poffo
Head of Institutional Cardiac Surgery – Hospital Israelita Albert Einstein – Sao Paulo – Brazil
1.POFFO, Robinson et al . Video-assisted cardiac surgery: results from a pioneer project in Brazil. Rev Bras Cir Cardiovasc, São José do Rio Preto , v. 24, n. 3, p. 318-326, Sept. 2009 .
2.POFFO, Robinson et al . Video-assisted minimally invasive mitral valve repair: periareolar approach. Rev Bras Cir Cardiovasc, São José do Rio Preto , v. 24, n. 3, p. 425-427, Sept. 2009 .
It’s really a privilege to participate of this paradigm shift and to see the transfer of knowledge applied to surgical science. The Periareolar ( PA) mammaplasty, an aesthetic reconstructive surgical procedure, was introduced in Brazil by the famous plastic surgeon Pitanguy. This idea was brightly imported from plastic to MICS by Poffo. Following his work, as soon as 2008, I introduced the PA approach in my MIS experience with gratifying results. I prefer to perform this access in men with a small extension to the right or both sides. The areolar scar just disappear soon after the procedure.