Conclusion
Minimally invasive port-access surgery is an equivalent alternative to
the conventional median sternotomy approach for the treatment of
all-kind of MV diseases, but offers an improved cosmetic result and
faster postoperative recovery as most important advantage. Despite an
inherent learning curve, this technique provides to achieve the same
results in terms of valve repair quality and clinical outcome.
Notwithstanding the commonly longer cardiopulmonary bypass and cardiac
arrest times, the impact on secondary organ function is comparable to
conventional median sternotomy, excepted for the lower systemic
inflammatory response by CRP counts. Hence, the postoperative increase
of CK-enzymes suggestive for enhanced rhabdomyolysis needs to be
accounted when procedural times tend to exceed the critical time
threshold for severe limb ischemia.
Therefore, MIVT should be offered as a first-line technique to all
patients with significant mitral valve disease, even with the need for
concomitant treatment of tricuspid valve dysfunction and atrial
fibrillation, guaranteeing that a clinical outcome and valve repair
quality can be accomplished, at least non-inferior to that of the
conventional approach through sternotomy.