Minimally Invasive Mitral Valve Surgery Using the FlexCrown Retractor: A Safe and Effective New Self-Expandable Left Atrial Exposure Device.

Objective: Minimally invasive mitral valve surgery (MIMVS) is being increasingly adopted worldwide. Pivotal to the safe conduct of the procedure is optimal visualization to allow detailed valve analysis and assessment of reparability. Positioning of conventional transthoracic left atrial retractors used during MIMVS may be time-consuming and can result in a limited view or thoracic bleeding. The aim of this study was to evaluate the safety and efficacy of the FlexCrown™ retractor by Geister (Tuttlingen, Germany), an innovative self-expandable left atrial retractor, during MIMVS.

Methods: A retrospective analysis was performed of 245 patients at 2 mitral specialist centers from January 2017 to July 2022. All patients underwent MIMVS via a right minianterolateral thoracotomy using the FlexCrown retractor.

Results: There were 129 female (53%) and 116 male (47%) patients with a mean age of 67 ± 10 years. The etiology of the mitral valve pathology was stenosis in 11% of patients (n = 27), regurgitation in 80% (n = 196), and mixed in 9% (n = 22). The device was used for both mitral valve repair (n = 125) and replacement (n = 120). There were no cases of tissue damage, dislodgement, or migration of the FlexCrown retractor. The postoperative transthoracic echocardiogram showed no or trivial mitral regurgitation in 90% of patients (n = 220).

Conclusions: The FlexCrown self-expandable left atrial retractor by Geister allows excellent and safe exposure of the mitral valve with fast deployment and removal during MIMVS. The use of this innovative retractor may represent a helpful alternative to conventional left atrial retractors.