The study period was between 1992 and 2009 and surgical approaches were sternotomy in 377, video-assisted right minithoracotomy in 481, or robot-assisted in 447. Mean followup was 6.4 �� 4.5 years (maximum, 19 Pacritinib FDA years) [45]. The 30-day mortality for isolated MV repair was similar for all approaches (P = 0.409). Fewer neurological events were observed in the videoscopic and robotic groups (P = 0.013). Adjusted survival was similar for all approaches (P = 0.357) [45]. Galloway and associates at the New York University have reported the longest outcomes for minimally invasive mitral valve surgery to date [46]. Between 1996 and 2008, they performed 1071 minimally invasive mitral valve repairs and compared their results with a cohort of 1601 conventional procedures.

Almost one third of the minimally invasive repairs included an anterior leaflet procedure and all patients received an annuloplasty device [46]. They reported a perioperative mortality of 1.3% in both groups with isolated mitral valve repair and no differences in major adverse events [46]. Long-term results were equivalent to sternotomy techniques. In isolated mitral valve repair, 8-year freedom from reoperation or severe recurrent insufficiency was 93% and freedom from all the valve related complications was 90%. At the same time, they had fewer transfusions, shorter lengths of hospital stay, and fewer septic complications [46]. 5. Neurological Events Due to the limited access to the operative field, there is the potential for inadequate deairing of the heart leading to an increased incidence of neurological events.

Mohr et al. [23] in their early series reported an 18% incidence of confusion, but were not using the CO2 insufflation��a technique they have since adopted. The same group after a decade observed postoperative neurological impairment in 41 of 1,339 patients (3.1%) who underwent mini-MVS, with 28 (2.1%) minor and 13 (1.0%) major events [22]. Grossi et al. [47] has recently published results of 1282 patients with an overall frequency of postoperative neurological event of 2.3% (30/1282). They also identified the high risk group for neurological event as those with peripheral vascular disease, cerebrovascular disease, dialysis, and atherosclerotic aortas [47] and also pointed out the use of retrograde arterial perfusion in diseased aortas as the most significant risk factor for the development of postoperative neurological event.

In contrast to this, Gammie et al. maintained that neither retrograde arterial perfusion nor the use of end balloon were risk Anacetrapib factors for development of postoperative neurological event [48]. This group studied 28,143 patients identified from the Society Of Thoracic Surgeons database and found a higher rate of permanent stroke, 1.87%, for the minimally invasive surgery group as opposed to 1.