The comparison of early outcomes in minimal invasive versus conventional mitral valve surgery.

Abstract

Objective: To compare early postoperative outcomes between MIMVS and conventional sternotomy at the Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore, a tertiary care cardiac center in Pakistan. Study Design: Prospective Cohort study. Setting: Department of Cardiac Surgery, Punjab Institute of Cardiology, Lahore. Period: 1^st September 2025 to 28^th January 2026. Methods: Consecutive patients with degenerative mitral valve disease undergoing surgery were enrolled (N=240), including 145 patients undergoing MIMVS and 95 undergoing conventional sternotomy. Preoperative characteristics, intraoperative parameters, postoperative outcomes, and organ-specific biomarkers were documented. Data analysis was performed using SPSS. A p-value <0.05 was considered statistically significant. Results: Baseline variables were comparable between groups. Cardiopulmonary bypass time was significantly longer in the MIMVS group compared to sternotomy (140.9 ± 39.4 vs 95.7 ± 38.3 min; p<0.001), as was aortic cross-clamp time (88.7 ± 30.6 vs 60.2 ± 23.0 min; p<0.001). Frequency of solated annuloplasty was more in MIMVS patients (29.0% vs 13.7%; p=0.007). Valve replacement was more common in the sternotomy group (33.7% vs 11.0%; p<0.001), as was concomitant tricuspid valve surgery (36.8% vs 19.8%; p=0.001). Thirty-day mortality (3.4% vs 1.1%; p=0.392) and stroke rates (2.8% vs 3.3%; p=0.642) were comparable. Hospital stay (14 ± 4 vs 15 ± 4 days; p=0.18) and ICU stay (1.4 ± 1.8 vs 1.7 ± 2.1 days; p=0.371) were similar between groups. C-reactive protein levels on postoperative day two were significantly lower in the MIMVS group compared to sternotomy (18.5 ± 19.1 vs 168.3 ± 74.9 mg/L; p<0.001), while creatine kinase levels were higher (932.9 ± 796.1 vs 609.1 ± 633.9 U/L; p=0.001). Conclusion: Minimally invasive mitral valve surgery represents a safe and effective alternative to conventional sternotomy in appropriately selected Pakistani patients. Despite longer procedural times, MIMVS provides comparable clinical outcomes with reduced systemic inflammatory response, supporting its use as a viable surgical option in tertiary cardiac centers.