Necessity Is the Mother of Invention: How Making Mitral Exposure Easier During Minimally Invasive Surgery Can Improve Adoption Rates

Abstract

Minimally invasive mitral valve surgery comes in many different forms. Although the adoption rate for minimally invasive mitral surgery in the United States had increased to 30% by 2018, it is still very low compared with other European countries.1 Dissecting the reasons for a low adoption rate compared with other specialties’ minimally invasive techniques, such as robotic prostatectomy, reveals it is not just about the instruments or the optics equipment used. The learning curve for minimally invasive mitral surgery can be steep, and 1 major reason for this is inadequate exposure or “setup.” In surgery, technique is “king” but exposure is “queen,” and the anterior annular–to–posterior leaflet stitch for traction technique described by Peña and colleagues in this issue of The Annals of Thoracic Surgery2 is a tool every minimally invasive mitral surgeon should master.