title: Cross-sectional survey on minimally invasive mitral valve surgery.
abstract: BACKGROUND
  Minimally invasive mitral valve surgery (MIMVS) has become a standard technique to perform mitral valve surgery in many cardiac centers. However, there remains a question regarding when MIMVS should not be performed due to an increased surgical risk. Consequently, expert surgeons were surveyed regarding their opinions on patient factors, mitral valve pathology and surgical skills in MIMVS.
  
  
  METHODS
  Surgeons experienced in MIMVS were identified through an electronic search of the literature. A link to an online survey platform was sent to all surgeons, as well as two follow-up reminders. Survey responses were then submitted to a central database and analyzed.
  
  
  RESULTS
  The survey was completed by 20 surgeons. Overall results were not uniform with regard to contraindications to performing MIMVS. Some respondents do not consider left atrial enlargement (95% of surgeons), complexity of surgery (75%), age (70%), aortic calcification (70%), EuroSCORE (60%), left ventricular ejection fraction (55%), or obesity (50%) to be contraindication to surgery. Ninety percent of respondents believe more than 20 cases are required to gain familiarity with the procedure, while 85% believe at least one MIMVS case needs to be performed per week to maintain proficiency. Eighty percent recommend establishment of multi-institutional databases and standardized surgical mentoring courses, while 75% believe MIMVS should be incorporated into current training programs for trainees.
  
  
  CONCLUSIONS
  These results suggest that MIMVS has been accepted as a treatment option for patients with mitral valve pathologies according the expert panel. Initial training and continuing practice is recommended to maintain proficiency, as well as further research and formalization of training programs.
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany;
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany;
authors.forename: Michael
authors.initials: M
authors.lastname: Borger
authors.affiliation: Departmemnt of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN, USA;
authors.forename: John G
authors.initials: JG
authors.lastname: Byrne
authors.affiliation: Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA;
authors.forename: W Randolph
authors.initials: WR
authors.lastname: Chitwood
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA;
authors.forename: Lawrence
authors.initials: L
authors.lastname: Cohn
authors.affiliation: Department of Cardiothoracic Surgery, New York University Medical Center, New York, NY, USA;
authors.forename: Aubrey
authors.initials: A
authors.lastname: Galloway
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany;
authors.forename: Jens
authors.initials: J
authors.lastname: Garbade
authors.affiliation: Cardiac Surgery Department, G. Pasquinucci Heart Hospital, Massa, Italy;
authors.forename: Mattia
authors.initials: M
authors.lastname: Glauber
authors.affiliation: Departments of Cardiovascular Surgery and Anaesthesia, Policlinica Gipuzkoa, San Sebastian, Spain;
authors.forename: Ernesto
authors.initials: E
authors.lastname: Greco
authors.affiliation: Division of Cardiovascular Surgery, Department of Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA, USA;
authors.forename: Clark W
authors.initials: CW
authors.lastname: Hargrove
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany;
authors.forename: David M
authors.initials: DM
authors.lastname: Holzhey
authors.affiliation: Heart Center Dortmund, Klinikum Dortmund gGmbH, Dortmund, Germany;
authors.forename: Ralf
authors.initials: R
authors.lastname: Krakor
authors.affiliation: Department of Cardiothoracic Surgery, New York University Medical Center, New York, NY, USA;
authors.forename: Didier
authors.initials: D
authors.lastname: Loulmet
authors.affiliation: Department of Cardiac Surgery, Escorts Heart Institute and Research Centre Ltd, Okhla Road, New Delhi, India;
authors.forename: Yugal
authors.initials: Y
authors.lastname: Mishra
authors.affiliation: Liverpool Heart and Chest Hospital, Liverpool, UK;
authors.forename: Paul
authors.initials: P
authors.lastname: Modi
authors.affiliation: Saint Joseph's Hospital of Atlanta, Atlanta, GA, USA;
authors.forename: Douglas
authors.initials: D
authors.lastname: Murphy
authors.affiliation: Department of Cardiovascular Sciences, East Carolina University, Greenville, NC, USA;
authors.forename: L Wiley
authors.initials: LW
authors.lastname: Nifong
authors.affiliation: Department of Cardiovascular Surgery, Keio University, Tokyo, Japan;
authors.forename: Kazuma
authors.initials: K
authors.lastname: Okamoto
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany;
authors.forename: Joerg
authors.initials: J
authors.lastname: Seeburger
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: David H
authors.initials: DH
authors.lastname: Tian
authors.affiliation: Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany;
authors.forename: Marcel
authors.initials: M
authors.lastname: Vollroth
authors.affiliation: The Collaborative Research (CORE) Group, Macquarie University, Sydney, Australia.
authors.forename: Tristan D
authors.initials: TD
authors.lastname: Yan
keywords: Minimally invasive mitral valve surgery; contraindications; cross sectional survey; surgical expertise; training programs