Should complex mitral valve repair be routinely performed using a minimally invasive approach?

To review selected recent publications on minimally invasive mitral valve surgery to help answer the question as to whether the minimally invasive approach should be routinely used in complex mitral valve repairs.

Other than cosmesis, there have not been demonstrable reproducible benefits of the minimally invasive approach. Although some workers report excellent results, there are other data that raise concern that complex repairs are less likely to be undertaken via the minimal access approach, resulting in lower repair rates, and also that the incidence of residual regurgitation may be higher. Some complications, such as stroke, may occur with greater frequency in patients having the minimally invasive approach.

The minimally invasive approach for complex mitral valve repair requires continued development and investigation, and current application should probably be largely restricted to high-volume reference minimally invasive surgery centers.