Conversion rate and contraindications for minimally invasive mitral valve surgery.

Over the past 15 years, minimally invasive mitral valve surgery via right lateral minithoracotomy has become the preferred method for mitral valve repair and mitral valve replacement in specialized centers worldwide. This technique refers to specific operation and visualization technologies and new perfusion methods. The minimally invasive approach affords faster patient recovery, less pain, shorter hospital stay and improved cosmesis. Moreover, minimally invasive mitral valve surgery may be an alternative to conventional mitral valve surgery, given that there is comparable short- and long-term mortality and comparable in-hospital morbidity. However, several studies have shown an increased risk of stroke, aortic dissection, groin infections, prolonged cross-clamp time and cardiopulmonary bypass time (1). Owing to severe intraoperative difficulties, conversion to full sternotomy is also a serious complication. At our institution, we have a very extensive experience with minimally-invasive mitral valve surgery, dating back to the late 1990s (2). We therefore aim to review the reasons and the early postoperative outcomes for those patients who underwent conversion to full sternotomy. Furthermore, we outline the contraindications for minimally-invasive mitral valve surgery.