Room Setup

High-definition monitors should be positioned across from the surgeon and the assistant, allowing all members of the surgical team to view the endoscopic image throughout the procedure.

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Patient Positioning

The optimal patient positioning for the µMVR™ procedure is supine, with both arms tucked and a right infrascapular roll placed to elevate the right hemithorax by approximately 20°.

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multiSTATION™ System Setup‍

Mounted directly to the table rails over the drape, the multiSTATION™ system provides a modular, readily adjustable platform for holding the endoscope, LSI’s customized equipment, and other surgical instruments during the procedure.

Surgical Incision

A microinvasive 3-6cm microthoracotomy incision in the second and third intercostal space can provide sufficient working space for most patients. Routine preoperative CT imaging enables careful assessment of the patient’s unique anatomy, especially regarding vascular access considerations. Placing the camera port and the aortic cross-clamp one intercostal space above the incision provides excellent visualization while maximizing working space.

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Pericardial Stay Suture Management

After opening the pericardium, retraction sutures are held using the low-profile RaPort™, which is inserted through the chest wall with a blunt obturator to minimize trauma and bleeding.

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Tensioning Stay Sutures

The miniRUMEL® provides for secure and readily-adjustable control of tension for venous, arterial, and purse string stay sutures.

Atriotomy

An atriotomy into the left atrium provides a clear pathway to the mitral valve annulus.

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Mitral Annular Exposure

[TO EDIT] The ViewSite Retractor helps expose, align, and stabilize the mitral annulus and the subvalvular apparatus, facilitating enhanced visualization.

Annular Suturing

The RAM® device shaft rotates and its tip angulates for ergonomic suture bite placement. Available with either 3.5 or 5.0 mm needle spacing, RAM® uses dual curved needles to place the first half of a horizontal mattress suture with a single squeeze and release of the lever. After each bite, the RAM® sutures are transferred to the SEW-EASY® cassette for the next step. RAM® annular suturing follows a pattern to minimize potential obstruction of endoscopic visualization.

Prosthetic Suturing

A single squeeze and release of the SEW-EASY® lever places both suture ends through the prosthetic valve sewing cuff at widths of either 3.5 or 5.0 mm. the assistant typically loads the cassette into the SEW_EASY device. The surgeon holds the prosthtic valve on a customized handle during suture palcementto enable rapid and precise control of this critical step.

Suture Securing

The COR-KNOT® promptly, reliably, and ergonomically secures valve sutures while providing multiple clinically demonstrated benefits to patients. Titanium fasteners have replaced the need for the hand-tying of over 20 million sutures.the COR-KNOT® approach enhances the surgeon’s ability to pursue the preferred “no-touch” principle in valve replacement.