Establishing Minimally Invasive Cardiac Surgery in a Developing Country: A Five-Year Experience at Hayatabad Medical Complex, Pakistan.

Background The adoption of minimally invasive cardiac surgery (MICS) has increased over the past 25 to 30 years, driven by advancements in technology and a growing understanding of its benefits. This study evaluates the outcomes of 144 elective MICS procedures performed between January 2019 and September 2024. Methods Patients underwent various surgical approaches, including upper mini-sternotomy, mini-thoracotomy, and sub-xiphoid access. Patient demographics, preoperative characteristics, and surgical outcomes were analyzed. A total of 144 MICS procedures were performed. Results The cohort had a mean age of 30.72 years, with a nearly equal gender distribution, indicating that MICS can be performed safely in Pakistani patients. The mean ejection fraction was 53.58%, with hypertension being the most common comorbidity (22.2%). Aortic cannulation was primarily utilized, and aortic valve replacement (AVR) was the most common procedure (44.4%). The mean cardiopulmonary bypass (CPB) time was 95.9 ± 56.3 minutes and the mean aortic cross-clamp time was 62.22 ± 57.004 minutes, demonstrating efficient procedural times. The overall incidence of complications was low, supporting the safety and efficacy of MICS. Conclusion Our findings suggest that MICS is a viable and effective approach for a diverse patient population, with favorable clinical outcomes. The results underscore the potential for MICS to become standard practice in cardiothoracic surgery. Future research should focus on long-term outcomes and the influence of comorbidities to further enhance MICS methodologies.