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BISMICS consensus statement: implementing a safe minimally invasive mitral programme in the UK healthcare setting
  1. Hunaid A Vohra1,
  2. M Yousuf Salmasi2,
  3. Lueh Chien3,
  4. Massimo Caputo1,
  5. Max Baghai4,
  6. Ranjit Deshpande5,
  7. Enoch Akowuah6,
  8. Ishtiaq Ahmed7,
  9. Michael Tolan8,
  10. Toufan Bahrami9,
  11. Steven Hunter10 and
  12. Joseph Zacharias11
  13. on behalf of the British and Irish Society for Minimally Invasive Cardiac Surgery
  1. 1Cardiac Surgery, Bristol Heart Institute, Bristol, Bristol, UK
  2. 2Surgery and Cancer, Imperial College London, London, United Kingdom, UK
  3. 3Faculty of Medicine, Imperial College London, London, London, UK
  4. 4Cardiothoracic Surgery, King's College Hospital NHS Foundation Trust, London, London, UK
  5. 5Cardiology, King's College Hospital, London, UK
  6. 6Cardiothoracic Surgery, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
  7. 7Cardiac Surgery, Brighton and Sussex NHS LKS Royal Sussex County Hospital, Brighton, Brighton and Hove, UK
  8. 8Cardiac Surgery, St James Hospital, Dublin, Ireland
  9. 9Cardiac Surgery, Harefield Hospital, Royal Brompton & Harefield NHS Foundation Trust, London, UK
  10. 10Cardaic Surgery, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, Sheffield, UK
  11. 11Lancashire Cardiac Centre, Blackpool Victoria Hospital, Blackpool, UK
  1. Correspondence to Dr M Yousuf Salmasi; y.salmasi{at}


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 postoperative bleeding, reduced wound infection, enhanced recovery and patient satisfaction. Technical considerations require specific attention and can be introduced through simulation and/or use in conventional cases. Either endoballoon or aortic cross clamping is 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, is an important step to consider. The importance of pre-empting complications and dealing with adverse events is described, including re-exploration, conversion to sternotomy, unilateral 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.

  • cardiac surgery
  • mitral regurgitation
  • minimally invasive

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  • HAV and MYS contributed equally.

  • Correction notice This article has been corrected since it was first published. 'Massimo Caputo' has been added as the 4th author and a funding statement has now been included.

  • Collaborators All authors collaborated to produce this article as members of the British and Irish Society for Minimally Invasive Cardiac Surgery (BISMICS).

  • Contributors All authors contributed to the production of this manuscript.

  • Funding The British Heart Foundation, Cardiovascular theme of NIHR Bristol Biomedical Research Centre, supported this work. The funders played no role in the design of the study, in the collection, analysis and interpretation of data, or in the decision to submit the manuscript for publication.

  • Competing interests JZ is a paid proctor for Edwards Lifesciences, Cryolife and Abbott.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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