Minimally invasive mitral valve surgery in a non-high volume center

Objectives. In September 2019, the preferred surgical approach shifted for patients undergoing mitral valve (MV) surgery at our institution. The aim of this study was to compare minimally invasive surgery (MIS) with prior conventional sternotomy (CS) approach, to assess quality and safety of MIS in a non-high volume center. Methods. This single-center retrospective observational study comprised 254 patients, 102 CS patients and 152 MIS patients, who underwent MV surgery for mitral regurgitation with or without concomitant procedures (i.e. tricuspid valve surgery, atrial fibrillation ablation, closure of ASD) between January 2015 and October 2023. Results. CS patients were older with a higher preoperative risk profile. Mitral repair was the predominant procedure regardless of surgical approach. MIS had longer intraoperative times, yet were equal to CS in regard to myocardial injury, intensive care unit stay and postoperative complications. MIS had lower rates of permanent pacemaker insertions (4% vs. 13%; p < .014) and a shorter postoperative length of stay (5 vs. 7 days; p < .001). The 30-day mortality was low (1% vs 2%; p > .5). Proposed learning curve of MIS was demonstrated by a tendency of reduced intraoperative times with growing experience. Conclusions. MIS is a feasible alternative to the CS approach for MV surgery even at non-high volume centers. MV surgery with MIS results in a shorter postoperative length of stay, with comparable outcomes in terms of low mortality as well as surgical and postoperative morbidity. We believe that the prolonged intraoperative times will shorten with increased experience of these procedures.