Is a minimally invasive approach for re-operative mitral valve surgery superior to standard resternotomy?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'Is a minimally invasive approach superior to standard sternotomy for re-operative mitral valve surgery?'. Altogether 48 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that minimally invasive mitral valve re-operation can be performed with an operative mortality similar to standard sternotomy approach but with a higher patient satisfaction. Less postoperative bleeding, reduced need for blood transfusion and absence of sternal wound infection are the main advantages of this technique. Mean hospital stays and ventilation time appear to be reduced with this approach.