However, they later abandoned this technique, given the lack of difference compared with their ��standard�� approaches. Recently in 2012, kinase inhibitor Tofacitinib Gao et al. reported successful robotically assisted mitral valve replacement with excellent results [33]. Figure 2 Heart Lung machine with peripheral cannulation via the femoral vessels. Figure 3 Direct transthoracic aortic clamping. 3. Results During the past 16 years, cardiac surgeons worldwide have reported their MIMVS data with promising results. The majority of these results suggest that MIMVS provide excellent, safe, and familiar exposure of the mitral valve with results comparable to those with conventional approaches. Unfortunately we lack data from large prospective randomized control series comparing the results of minimally invasive versus the conventional sternotomy technique.

We therefore have to rely on retrospective analysed registry data (mostly single centre). 4. Mortality Reviewing all comparative MIMVS studies evaluating mortality, no study has shown a significant difference between minimally invasive and conventional approaches [34�C40]. In 2003, Greelish et al. [20] reported the first long-term results (5-year followup) of mini-VS, indicating a freedom from mitral regurgitation and reoperation >90%. In their early port access cases, Mohr et al. [23] reported a high mortality rate (9.8%) for mini-MVS, partially procedure related, with 2 of 51 patients experiencing an aortic dissection [23]. After discontinuing the port access technique and modification and simplification of the surgical procedure, the mortality decreased to an in-hospital mortality rate of 3.

9% [41]. The Leipzig long-term results revealed an actuarial survival rate of 83% at 6.8 years [42]. When excluding the initial 200 patients in whom an endoclamp was used, the overall results are even more impressive [42]. In 2002, Mohr’s group (Onnasch et al. [36]) reported their 5-year experience performing mini-MVS in 449 patients, with a mean survival rate of 96.3% at 2-year followup. The East Carolina University group reported a combined series with Hargrove consisting of 1178 successful video-assisted mitral valve operations between 1996 and 2008 [43]. The operative mortality rates for mitral valve repair and replacement for this two center series were 2.1% and 4.6%, respectively, but only 0.2% for isolated primary mitral valve repair.

A recent meta-analysis by Modi et al. [44] identified ten papers published between 1998 and 2005 which were suitable for analysis. This study included 1358 minimally invasive patients and 1469 sternotomy patients. Although cross-clamp and cardiopulmonary bypass time were longer in the minimally invasive group, there were no difference Anacetrapib in mortality, stroke, reoperation for bleeding, new onset atrial fibrillation, or duration of ICU stay or hospital stay [44]. In a more recent study, Stevens et al.