Introduction
Minimally invasive mitral valve surgery is a valid and well-established alternative to a conventional approach (1). In case series comparing minithoracotomy to conventional sternotomy, better results were achieved in patients treated with a minimally invasive approach in terms of a faster and complication-free postoperative course (2,3). Notwithstanding this, several doubts remain about its feasibility, learning curve and outcomes (4). This is because the duration of the procedure, especially in the learning phase, would be longer than that obtained using a sternotomy approach. Other authors argue, however, that the minimally invasive approach allows, paradoxically, a better visualization of the mitral valve, resulting in “simpler” repairability of the valve itself (5).
Furthermore, some authors suppose that the advantage for patients undergoing a minimally invasive approach would be only of an esthetic nature, therefore the procedure should be favored only in young and anatomically suitable patients (6). Conversely, for other authors, precisely in patients most at risk, the minimally invasive approach, reducing surgical trauma, can achieve a better postoperative outcome (5).
In summary, the debate on the usefulness of the minimally invasive approach in mitral surgery and in which patients it should be performed is still open. The purpose of our study is to show an extensive single-center case series of minimally invasive reconstructions of the mitral valve which, by institutional policy, are performed in all patients who come with an indication for isolated mitral valve surgery.