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Minimal Access Cardiac Surgery: State of the Art and Future...
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Minimal Access Cardiac Surgery: State of the Art and Future Perspectives, 2nd Edition

A Special Issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425) belonging to the section "Cardiac Surgery".

Deadline for manuscript submissions: 31 December 2026 | Viewed by 2867

Editor

Dr. Jason M. Ali

E-Mail Website
Guest Editor
Department of Cardiothoracic Surgery, Royal Papworth Hospital NHS Foundation Trust, Cambridge Biomedical Campus, Cambridge CB2 0AY, UK
Interests: minimal-access cardiac surgery; risk scoring; EuroSCORE; postoperative outcomes; heart and lung transplantation
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As with all areas of surgical practice, there has been a move in recent years towards minimally invasive approaches to many operations. For example, VATS lobectomy is becoming the standard of care. In cardiac surgery, I think it fair to term these approaches requiring minimal access, rather than being minimally invasive, since the invasiveness of the surgery, in terms of cardiopulmonary bypass, cardioplegic arrest, the opening of cardiac chambers, and other aspects, is much the same.

There are an increasing number of centres offering minimal-access cardiac surgery, and the range of procedures offered is expanding. Patients like the idea of minimal-access procedures for a range of reasons: improved cosmesis, the perception of a faster recovery, and reduced pain. Interestingly though, there remains some scepticism among the cardiac surgery community as to the true benefit of minimal-access cardiac surgery. Indeed, there are very few randomised controlled trials that compare outcomes to standard cardiac surgery.

In some ways, it is this scepticism that prompts this timely Special Issue, where the current status of minimal-access cardiac surgery will be explored, together with a consideration of future advances and directions, to provide the cardiac surgery community with a robust review of the current literature.

Dr. Jason M. Ali
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-anonymized peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Cardiovascular Development and Disease is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • minimal access
  • minimally invasive
  • robotic
  • robot-assisted
  • cardiac surgery

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Related Special Issue

Published Papers (4 papers)

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Research

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17 pages, 993 KB  
Article
Comparative Evaluation of Clinical Outcomes Following Endovascular and Hybrid Repair of Aortic Arch Aneurysms
by Yulia Panteleeva, Almaz Vanyurkin, Ekaterina Verkhovskaya, Sergey Kogay, Natalya Maystrenko, Mikhail Chernyavskiy, Dmitry Kudlay and Anna Starshinova
J. Cardiovasc. Dev. Dis. 2026, 13(8), 396; https://doi.org/10.3390/jcdd13080396 - 18 Aug 2026
Viewed by 274
Abstract
Objective: The aim of this study was to evaluate the efficacy and safety of endovascular and hybrid treatment approaches in patients with aortic arch aneurysms. Materials and Methods. This retrospective study included 68 male and female patients with a confirmed diagnosis of either [...] Read more.
Objective: The aim of this study was to evaluate the efficacy and safety of endovascular and hybrid treatment approaches in patients with aortic arch aneurysms. Materials and Methods. This retrospective study included 68 male and female patients with a confirmed diagnosis of either an aortic arch aneurysm or a descending thoracic aortic aneurysm with a short proximal landing zone (<1.5 cm) who underwent either hybrid or endovascular treatment at the Department of Vascular Surgery between January 2017 and December 2024. Study outcomes included a composite measure of technical success, a composite measure of in-hospital clinical success, and a composite measure of long-term treatment outcomes, including stroke, myocardial infarction, and aortic-related mortality. Results. All 68 patients were divided into two groups: Group I comprised patients who underwent endovascular treatment, whereas Group II included patients who underwent hybrid surgical treatment. The groups were comparable with regard to demographic and anatomical characteristics, clinical presentation, and comorbidities. The composite technical success rate (defined as successful target stent-graft deployment without conversion to open surgery and absence of type I or type III endoleaks) was comparable between the groups at the intraoperative stage (p = 1.000). The composite measure of in-hospital clinical success was achieved in 33 patients (94%) in Group I and 22 patients (67%) in Group II and was significantly higher in the endovascular group (adjusted p = 0.005). This difference was primarily attributable to a higher incidence of complications in the hybrid treatment group, including stroke (9%) and peripheral nerve injury (9%), associated with the open surgical component of the procedure. The mean follow-up duration was shorter in Group I (19.3 ± 10.4 months) than in Group II (63.9 ± 29.5 months), reflecting the fact that most patients in Group I underwent treatment during the later years of the study period. Although a difference in the composite long-term outcome measure was observed before adjustment (p = 0.031), this finding did not remain statistically significant after correction for multiple testing (adjusted p = 1.000). Conclusions. In this preliminary single-centre study, endovascular and hybrid approaches showed comparable technical efficacy in the early postoperative period. However, hybrid surgical treatment was associated with a less favourable safety profile during the early postoperative period, as reflected by the significantly lower in-hospital composite clinical success rate and longer hospital stay than in the endovascular group. These findings remained robust after correction for multiple testing. Long-term results should be interpreted with caution and require confirmation in larger prospective studies with longer and balanced follow-up periods. Full article
(This article belongs to the Special Issue Minimal Access Cardiac Surgery: State of the Art and Future Perspectives, 2nd Edition)
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Review

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9 pages, 2131 KB  
Review
Beyond Surgical Access: Evidence Supporting a Multidimensional Concept of Surgical Invasiveness in Contemporary Cardiac Surgery
by Salvatore Poddi and Alessio Rungatscher
J. Cardiovasc. Dev. Dis. 2026, 13(7), 315; https://doi.org/10.3390/jcdd13070315 - 8 Jul 2026
Viewed by 453
Abstract
Minimally Invasive Cardiac Surgery (MICS) has traditionally been defined according to the extent of surgical access, primarily focusing on the avoidance of full sternotomy and the reduction in incision size. However, the rapid evolution of cardiac surgery, including technological innovation, robotic platforms, hybrid [...] Read more.
Minimally Invasive Cardiac Surgery (MICS) has traditionally been defined according to the extent of surgical access, primarily focusing on the avoidance of full sternotomy and the reduction in incision size. However, the rapid evolution of cardiac surgery, including technological innovation, robotic platforms, hybrid procedures, and enhanced perioperative management, has progressively challenged the adequacy of purely anatomical definitions of invasiveness. Contemporary surgical practice suggests that the overall impact of a procedure on the patient extends beyond the surgical incision itself and includes several physiological and patient-centered dimensions. This narrative review discusses the contemporary meaning of invasiveness in cardiac surgery and examines the limitations of conventional definitions of MICS based exclusively on surgical exposure. This narrative review is based on a non-systematic literature search of PubMed, Scopus, and Web of Science, and uses a thematic synthesis approach to explore the multidimensional concept of surgical invasiveness in cardiac surgery. Particular attention is given to the growing role of patient-centered outcomes and perioperative burden in defining procedural invasiveness. Building upon emerging conceptual perspectives in the literature, this review highlights a multidimensional interpretation of MICS, in which technical, physiological, and recovery-related factors collectively contribute to the assessment of surgical invasiveness. Full article
(This article belongs to the Special Issue Minimal Access Cardiac Surgery: State of the Art and Future Perspectives, 2nd Edition)
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16 pages, 1172 KB  
Review
Simulation Training in Video-Assisted and Robotic-Assisted Cardiac Surgery: A Narrative Review
by Fatemeh H. Nameghi and Jason M. Ali
J. Cardiovasc. Dev. Dis. 2026, 13(5), 180; https://doi.org/10.3390/jcdd13050180 - 26 Apr 2026
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Abstract
Minimal access cardiac surgery (MACS) can mitigate the increasing risk profile of cardiac surgery patients and is associated with improved postoperative outcomes. One of the ways to manage the steep learning curve of MACS is the use of surgical simulation training. We conducted [...] Read more.
Minimal access cardiac surgery (MACS) can mitigate the increasing risk profile of cardiac surgery patients and is associated with improved postoperative outcomes. One of the ways to manage the steep learning curve of MACS is the use of surgical simulation training. We conducted a narrative review to identify the relevant literature discussing MACS simulation training. We identified 20 studies using our search strategy. Various platforms were represented: high-fidelity (n = 8), low-fidelity (n = 6), and animal studies (n = 6). Virtual reality (VR) appeared in two wet-lab studies as an adjunct. The surgical approach was video-assisted thoracoscopic surgery (VATS) in 11 and robotic-assisted thoracoscopic surgery (RATS) in nine. The most simulated procedure was minimal access mitral valve (MV) repair (n = 16). Most studies (n = 16) evaluated the impact of simulation training on the surgical skill of participants with varying baseline MACS experience. A small proportion of included studies (n = 4) carried out only fidelity testing. While some standardised assessment tools were used, there was considerable variation in how surgical skill and fidelity were assessed. There are an increasing number of publications on MACS simulation training, with equal focus on bench and animal models. MV procedures were the most simulated, suggesting a drive towards increasing the scope of minimal access MV training. Full article
(This article belongs to the Special Issue Minimal Access Cardiac Surgery: State of the Art and Future Perspectives, 2nd Edition)
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Other

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16 pages, 3754 KB  
Systematic Review
Feasibility and Safety of Operating Room Extubation After Minimally Invasive Cardiac Valve Surgery: A Systematic Review and Meta-Analysis
by Dimitrios E. Magouliotis, Serge Sicouri, Vasiliki Androutsopoulou, Massimo Baudo, Vanesa Brecher, Dimitrios V. Avgerinos, Thanos Athanasiou and Basel Ramlawi
J. Cardiovasc. Dev. Dis. 2026, 13(8), 368; https://doi.org/10.3390/jcdd13080368 - 4 Aug 2026
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Abstract
Background: Minimally invasive cardiac valve surgery has emerged as a preferred approach in selected patients, yet optimal postoperative extubation timing remains debated. This systematic review and meta-analysis examined clinical outcomes associated with extubation in the operating room (OR) versus the intensive care unit [...] Read more.
Background: Minimally invasive cardiac valve surgery has emerged as a preferred approach in selected patients, yet optimal postoperative extubation timing remains debated. This systematic review and meta-analysis examined clinical outcomes associated with extubation in the operating room (OR) versus the intensive care unit (ICU) among adult patients undergoing minimally invasive cardiac valve surgery. Methods: The study was conducted according to PRISMA guidelines. A single unit of analysis was applied throughout. Pooled odds ratios were computed with the Mantel–Haenszel random-effects method; where a study reported only a matched or covariate-adjusted estimate, that estimate was reserved for a prespecified sensitivity analysis using the generic inverse-variance method. Results: Five observational studies (2023–2025) including 1101 OR-extubated and 899 ICU-extubated patients from high-volume centers with fast-track or enhanced recovery pathways were included. OR extubation was associated with lower odds of reintubation (OR 0.40; 95% CI 0.24–0.69; I2 = 0%), postoperative delirium (OR 0.47; 95% CI 0.31–0.72; I2 = 0%), and pneumonia (OR 0.30; 95% CI 0.16–0.53; I2 = 0%). No significant differences were observed for new-onset atrial fibrillation, stroke, or reoperation for bleeding. Thirty-day mortality was reported by four of the five studies and comprised few events (5 of 1043 ORE versus 17 of 645 ICE across the four studies reporting this outcome); given the small number of events, the concentration of deaths in the higher-risk ICU-extubated patients, and the reliance of the pooled estimate on two confounded cohorts, this difference is not interpretable as a treatment effect, and no pooled odds ratio is reported here. Length of stay was consistently shorter after OR extubation but was not pooled because of extreme heterogeneity (I2 = 96–100%). Sensitivity analyses using adjusted estimates attenuated the associations for reintubation and pneumonia, consistent with substantial confounding by indication. Conclusions: In appropriately selected patients undergoing minimally invasive valve surgery, OR extubation is feasible and is associated with a recovery profile at least comparable to that of ICU extubation. Because extubation location was determined largely by intraoperative and early postoperative stability, these associations should be read as reflecting patient selection rather than a causal benefit of the strategy. The findings support the feasibility of OR extubation in appropriately selected patients at experienced centers and motivate prospective, ideally randomized, evaluation. Full article
(This article belongs to the Special Issue Minimal Access Cardiac Surgery: State of the Art and Future Perspectives, 2nd Edition)
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