Single-Center Experience With Minimally Invasive Approaches From Sternotomy to Thoracoscopy: Assessing the Learning...

Area of Science:

• Cardiovascular Surgery
• Minimally Invasive Procedures
• Surgical Outcomes

Background:

• Cardiac surgery is transitioning from traditional full sternotomy (FS) to minimally invasive cardiac surgery (MICS) due to patient benefits.
• MICS adoption faces challenges including a learning curve, technical complexity, and specialized training requirements.
• Evaluating the initial safety and outcomes of a new MICS program is crucial for wider implementation.

Purpose of the Study:

• To assess the initial outcomes and safety of a newly established minimally invasive cardiac surgery (MICS) program.
• To compare the early results of MICS procedures with concurrent traditional full sternotomy (FS) cases.

Main Methods:

• A single-center prospective cohort study included 98 patients undergoing primary, elective single-valve surgery from November 2024 to April 2025.
• Patients were divided into an initial MICS group (n=30) and a control FS group (n=68) with a higher risk profile.
• Outcomes including operative times, blood loss, transfusion needs, pain, recovery metrics, and safety endpoints were compared.

Main Results:

• MICS group had longer operative and bypass times but significantly less blood loss and lower transfusion requirements.
• MICS patients showed improved postoperative outcomes: lower pain, faster mobilization, shorter hospital stays, and quicker return to normal activity.
• Phrenic nerve palsy was higher in the MICS group (16.7%), but no significant differences in mortality, stroke, or reoperation for bleeding were observed.

Conclusions:

• The initial implementation of a minimally invasive cardiac surgery program is safe and offers significant patient benefits, including enhanced recovery.
• A learning curve is evident, indicated by longer procedure times and increased phrenic nerve palsy, necessitating careful patient selection and team training.
• Establishing an MICS program is feasible without compromising fundamental patient safety, supporting its wider adoption.