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Minimally Invasive Approach for Mitral Valve Surgery Is Associated With Increased Risk of Postoperative Diaphragm

Sameer K Singh1, Marco Tagliafierro1, Darina Kirilina1

  • 1Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University, New York, NY, USA.

Innovations (Philadelphia, Pa.)
|May 16, 2026
PubMed
Abstract

Insights

Minimally invasive mitral valve surgery increases the risk of diaphragm dysfunction compared to full sternotomy. Elderly patients with this complication experienced longer ventilation times and hospital stays.

Area of Science:

  • Cardiothoracic Surgery
  • Thoracic Surgery
  • Minimally Invasive Surgery

Background:

  • Minimally invasive mitral valve (MIMV) surgery offers benefits like reduced pain and faster recovery.
  • Postoperative diaphragm dysfunction (DD) is a potential complication, but data after MIMV is limited.

Purpose of the Study:

  • To investigate the incidence and impact of postoperative diaphragm dysfunction (DD) following minimally invasive mitral valve (MIMV) surgery.
  • To compare the risk of DD between MIMV and full sternotomy (FS) approaches.

Main Methods:

  • Retrospective analysis of 1,155 patients undergoing isolated mitral valve surgery (2015-2024).
  • Comparison between MIMV (right thoracotomy) and full sternotomy (FS) groups.
  • Diagnosis of DD confirmed by chest X-ray and ultrasound sniff test.

Main Results:

  • Overall DD incidence was 3.0%, with 9.3% in MIMV vs. 1.8% in FS (P < 0.001).
  • MIMV was independently associated with higher DD risk (OR=5.1).
  • Elderly patients (>70) with DD had longer ventilation times and hospital stays.

Conclusions:

  • MIMV via right thoracotomy is linked to a higher risk of postoperative DD.
  • Elderly patients with DD after MIMV face prolonged ventilation and hospitalization.
  • Further research is needed to understand and prevent diaphragm injury during MIMV.
Keywords:
diaphragm dysfunctiondiaphragm paralysisminimally invasive mitral valve

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