018), and a higher proportion of ST patients required readmission within 1 year (P = 0.023). Eight of 14 studies reported a shorter hospital stay with a minimally invasive approach [7, 9, 34, 37�C39, 63, 67, 68]. Only 5 studies were eligible for the meta-analysis of Modi et al. [44], and although Gefitinib the trend indicated this to be the case, the result was not statistically significant (350 patients, P = 0.07). Chitwood et al. [9], Cohn et al. [7], and Navia and Cosgrove [6] equated this trend to a 34%, 20%, and 7% cost saving, respectively. Moreover, these patients had fewer requirements for rehabilitation, a significant advantage in health care savings; 91% were discharged home compared with 67% with conventional approach [7, 67]. 11.

Operative Time Being one of the consistent findings from various case series from the last decade, it was evident that the operative time (cardiopulmonary bypass and cross clamp time) for MIMVS is more than that of conventional surgery. There was evidence suggesting that parity can be achieved with experience while certain high volume centres report shorter operative times with MIMVS [67]. Recent study by Gammie et al. [48] with a population of 28,143 patients from the STS database also showed that the median cardiopulmonary bypass and cross-clamp times were longer in the less-invasive group compared with the conventional group (cardiopulmonary bypass time 135 versus 108 minutes, respectively; P < 0.0001; cross-clamp time 100 versus 80 minutes, respectively; P < 0.0001). The median operative time was longer (4.2 versus 3.4 hours, P < 0.

0001) in the less-invasive group. 12. Intermediate and Long-Term Results Modi et al. [44], in his meta-analysis, considered recent data from 10 cohorts with 6479 patients and found that crude unadjusted mortality rates for the entire cohort are 1.1% for mitral valve repair and 4.9% for mitral valve replacement. Galloway et al. [46] have published the longest term of followup of their MIMVS and found hospital mortality to be 2.2% for all patients (36 of 1601), 1.3% for isolated minimally invasive (9 of 712), and 1.3% (3 of 223) for isolated sternotomy mitral valve repair, as well as 3.6% (24 of 666) for valve repair plus a concomitant cardiac procedure. For isolated valve repair, 8-year freedom from reoperation was 91%��2% for sternotomy and 95%��1% for minimally invasive (P = 0.

24), and 8-year freedom from reoperation or severe recurrent insufficiency was 90%��2% for sternotomy and 93%��1% for minimally invasive (P = 0.30). Eight-year freedom Drug_discovery from all valve-related complications was 86%��3% for sternotomy and 90%��2% for minimally invasive (P = 0.14) [46]. 13. Limitations of MIMVS Clearly, there is a learning curve for the surgeon as well as the anesthetists, perfusionists, and nursing teams. Mohr et al. reported a high mortality (9.