The Society of Thoracic Surgeons database considers "any procedure not performed with a full sternotomy and CPB support" a minimally invasive procedure. The practical applications of "mini-valve surgery" include partial sternotomy, thoracotomy, and video- and robot-assisted procedures. The downsides to minimally invasive approaches include difficulty converting to a sternotomy in the case of cannula displacement or aortic dissection, and complications of femoral artery cannulation (arterial dissection, infection, hematoma, and distal ischemia). The anesthetic management varies from standard sternotomy cases, including single-lung ventilation for thoracotomy approaches and transjugular coronary sinus catheters to provide retrograde cardioplegia. Intraoperative TEE is especially critical in these cases to monitor for cardiac distention, removal of air, and cannula placement. There is a significant learning curve to provide an equivalent surgical outcome with a "mini" versus traditional strategy. In successful procedures, patients enjoy improved cosmesis and decreased bleeding, wound infection, pain, and hospital length of stay. Unfortunately, in high-risk patients, the increased time of aortic cross-clamping and CPB can be deleterious. Complications can be severe, including aortic dissection and death. Mini-valve surgery is limited to patients with isolated valve disease.

References

• Bouhout I, Morgant MC, Bouchard D. Minimally invasive heart valve surgery. Can J Cardiol. 2017;33:1129-1137.
• Fitzgerald MM, Bhatt HV, Schuessler ME, et al. Robotic cardiac surgery part I: anesthetic considerations in Totally Endoscopic Robotic Cardiac Surgery (TERCS). J Cardiothorac Vasc Anesth. 2020;34:267-277.
• Langer NB, Argenziano M. Minimally invasive cardiovascular surgery: incisions and approaches. Methodist Debakey Cardiovasc J. 2016;12:4-9.