BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Disseminating the practice of minimally invasive mitral surgery (mini-MVS) can be challenging, despite its original case reports a few decades ago. The penetration of this technology into clinical practice has been limited to centres of excellence and mitral surgery in most general cardiothoracic centres remains to be conducted via sternotomy access as a first line. The process for the uptake of mini-MVS requires clearer guidance and standardisation for the processes involved in its implementation.
In this statement, a consensus agreement is outlined that describes the benefits of mini-MVS, including reduced post-operative bleeding, reduced wound infection, enhanced recovery and patient satisfaction. Technical considerations require specific attention and can introduced through simulation and/or use in conventional cases. Either endoballoon or aortic cross clamping are both recommended as well as femoral or central aortic cannulation, with the use of appropriate adjuncts and instruments.
A coordinated team-based approach that encourages ownership of the programme by the team members is critical. A designated proctor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases are important steps to consider.
The importance of pre-empting complications and dealing with adverse events are described, including re-exploration, conversion to sternotomy, uni-lateral pulmonary oedema and phrenic nerve injury. Accounting for both institutional and team considerations can effectively facilitate the introduction of a mini-MVS service. This involves simulation, team-based training, visits to specialist centres and involvement of a designated proctor to oversee the initial cases.
In this statement, a consensus agreement is outlined that describes the benefits of mini-MVS, including reduced post-operative bleeding, reduced wound infection, enhanced recovery and patient satisfaction. Technical considerations require specific attention and can introduced through simulation and/or use in conventional cases. Either endoballoon or aortic cross clamping are both recommended as well as femoral or central aortic cannulation, with the use of appropriate adjuncts and instruments.
A coordinated team-based approach that encourages ownership of the programme by the team members is critical. A designated proctor is also recommended. The organisation of structured training and simulation, as well as planning the initial cases are important steps to consider.
The importance of pre-empting complications and dealing with adverse events are described, including re-exploration, conversion to sternotomy, uni-lateral pulmonary oedema and phrenic nerve injury. Accounting for both institutional and team considerations can effectively facilitate the introduction of a mini-MVS service. This involves simulation, team-based training, visits to specialist centres and involvement of a designated proctor to oversee the initial cases.
Date Issued
2020-12-01
Date Acceptance
2020-08-25
Citation
Open Heart, 2020, 7 (2)
ISSN
2053-3624
Publisher
BMJ Publishing Group
Journal / Book Title
Open Heart
Volume
7
Issue
2
Copyright Statement
© 2020 Author(s) (or their employer(s)). Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. http://creativecommons.org/licenses/by-nc/4.0/
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.
License URL
Publication Status
Published
Article Number
e001259
Date Publish Online
2020-10-05