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.