Minimally invasive mitral valve repair: the Liverpool Heart and Chest Hospital Technique—tips for safely negotiating the learning curve

Minimally invasive mitral valve surgery (MIMVS) is technically challenging with a learning curve of 75-125 cases, and aspects of the procedure such as a 4 cm incision, no rib spreading, endoaortic balloon occlusion and a totally thoracoscopic technique increase the level of difficulty (1). Undoubtedly, one year of fellowship training in a high volume centre with plenty of operative exposure is important, but starting a new programme can still be daunting especially in the era of surgeon-specific data reporting. Selection of appropriate patients is probably the most important variable; choice of less complex repairs in patients with a normal body mass index (BMI) and no aortic valve incompetence is helpful. Thereafter, avoiding aspects of the technique that increase the level of difficulty becomes important. This video demonstrates a simple and reproducible technique that provides a safe platform that can be built upon as one’s experience increases. It is a good starting point for surgeons wishing to introduce this into their practice and safely negotiate the learning curve.