Update on minimally invasive coronary artery and valvular surgery

The introduction of minimally invasive techniques represents the most dramatic and controversial new development in cardiac surgery. Almost all minimally invasive surgery involves modified standard incisions and at least partial direct vision of the operative field. Therefore, minimally invasive cardiac surgery is defined as an operation through a smaller than usual incision. The procedures then can be divided into those with or without cardiopulmonary bypass. They can be applied in coronary artery bypass grafting or in valvular operations. Ultimately, almost all cardiac surgery could be performed in a minimally invasive fashion. However, the dominance of any type of procedure will depend on data supporting effectiveness, relative technical ease, ultimate cost savings, and improved patient outcome. Many of these data are lacking or are preliminary. Prospective, randomized comparisons are needed.