Cor Vasa 2026, 68(5):522-527 | DOI: 10.33678/cor.2026.027

Minimally invasive thoracoscopic vs. sternotomy approach in mitral valve surgery

Jana Čobejová, Tomáš Toporcer, Peter Šafár, Štefánia Mižáková, Lukáš Vajda, Štefan Lukačín, Adrián Kolesár

Department of Heart Surgery, East Slovak Institute of Cardiovascular Diseases and Medical Faculty, Pavol Jozef Šafárik University, Košice, Slovakia

Introduction: In recent decades, minimally invasive cardiac surgery (MIMVS) has become an increasingly popular surgical approach alongside the standard approach to the mitral valve using complete median sternotomy. The aim of this study was to retrospectively compare the results of mitral valve surgery using video-assisted thoracoscopy (VATS) and standard sternotomy (ST).

Methods: A retrospective analysis was performed on patients (n = 123) who underwent mitral valve surgery. They were divided into ST (n = 69) and VATS (n = 54) groups. Various preoperative, surgical, and postoperative parameters were examined, including survival and major adverse cardiac events (MACE), which included stroke, myocardial infarction, severe arrhythmia and death.

Results: Preoperatively, the main difference was in EuroScore, with the ST group being at higher risk (0.94 vs. 0.73, p <0.0001). In the VATS group, conservative surgery prevailed (94 vs. 55%, p <0.0001), while in the ST group, valve replacements prevailed (45 vs. 6%, p <0.0001). Patients after VATS had longer cardiopulmonary bypass (CPB) and aortic clamp times (146 vs. 91.8 min; p <0.0001; 110 vs. 75.5 min; p <0.0001). Echocardiographically, there were no statistically significant differences in postoperative pressure gradients across the mitral valve or in left ventricular remodeling in the mitral valve repair (MVP) subgroup. Survival rates and MACE were similar. In the postoperative period, the ST group had a higher incidence of pericardial effusion evacuation (12 vs. 0%, p <0.01) and blood plasma administration (1.17 vs. 0.46, p <0.001). Monitoring of postoperative complications such as revision, wound infection, fluidothorax puncture, pneumothorax drainage, TKS implantation, atrial fibrillation, length of hospitalisation, neurological complications, and the need for CVVHD did not reveal any statistically significant differences.

Conclusion: The data suggest that VATS offers comparable surgical results to ST in mitral valve surgery with additional cosmetic advantages.

Keywords: Minimally invasive surgery, Mitral regurgitation, Mitral valve, Sternotomy

Received: February 27, 2026; Revised: February 27, 2026; Accepted: March 14, 2026; Prepublished online: October 5, 2026; Published: October 20, 2026  Show citation