State-of-the-art surgical approaches in minimally invasive aortic valve surgery

Over the past 30 years, minimally invasive cardiac surgery has progressed from single case reports of operations via thoracotomy and various procedures of partial sternotomy to routine use of mini-accesses as well as fully thoracoscopic and robotic techniques. It is aortic valve surgery that implemented minimally invasive technologies most widely. The objective of this systematic review is to present state-of-the-art approaches to minimally invasive aortic valve surgery including patient selection criteria as well as evolution and state-of-the-art of the main surgical approaches. The search strategy covered international databases, such as PubMed, Scopus, Embase, and Web of Science. We used following queries: 'minimally invasive surgery of the aortic valve', 'alternative surgical approaches in aortic valve surgery', 'minimally invasive autologous pericardium neocuspidization'. Selection of patients for minimally invasive aortic interventions should consider both the anatomy of the mediastinum and the aortic root as well as cardiac and other comorbidities. Minimally invasive approaches in aortic valve surgery include thoracotomy, partial sternotomy, and endoscopic techniques. Of particular interest is minimally invasive neocuspidization with autologous pericardium. Partial sternotomies are the most routinely used approaches in aortic valve surgery. Their cumulative outcomes allow to compare their efficacy and safety with those of classic sternotomy access within large meta-analyses. Minimally invasive autopericardial neocuspidization and endoscopic interventions on the aortic valve require further surgical experience and clinical outcomes.