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.