Most of the published series continue inhibitor licensed to implicate MIMVS done on the beating heart as increasing the risk of perioperative stroke. Further disadvantages with MIMVS are related to the use of femoral cannulation and perfusion, with groin complications (e.g., infections and arterial dissections/haematoma) accounting for morbidity unseen with conventional sternotomy. As for the future, minimally invasive cardiac surgery is likely to become more widely adopted as growth in this niche market and cardiac surgery as a whole is often patient-driven, much in the same way that percutaneous intervention for multivessel disease has been. In essence, patients do not want a sternotomy and it is important as a surgical community that we realize this.

However, despite enthusiasm, caution cannot be overemphasized as traditional cardiac operations still enjoy proven long-term success and ever-decreasing morbidity and mortality and remain our benchmark measures for comparison. To pave the path towards totally endoscopic valve surgery, surgeons, cardiologists, and engineers must focus on improving the methods of computerization of the instruments. Patient requirements, technology development, and surgeon capabilities all must be aligned to drive these needed changes. Minimally invasive valve surgery is an evolutionary process, and there must be a well-balanced alignment between the surgeons and the cardiologists to derive the maximal benefit that this technology has to offer. Traditional valve operations enjoy proven long-term success with ever-decreasing morbidity and mortality and remain the gold standard.

Minimally invasive surgeries are probably not going to replace the gold standard, but they should present themselves as an alternative for treatment of mitral valve diseases with equal long-term GSK-3 durability.
The surgical technique has been previously described by us and others [11, 12]. Briefly, all operations are performed under general anesthesia. Prior to positioning, the patient’s head is secured in a Mayfield clamp. The body is then turned in a full lateral position with an axillary role. The patient is taped down securely, and the head is flexed approximately two fingerbreadths from the sternum and rotated 70�C80 degrees away from the side of the operation in order to maintain the vertex parallel to the floor. In this position, the cranial nerve 7-8 bundle is more inferior to the trigeminal nerve. A small region of hair is shaved postauricularly, and a 4�C6cm linear incision is made just inferior to the junction of the transverse and sigmoid sinuses and approximately one centimeter behind the patient’s hairline. The burr hole for the craniectomy is placed just posterior to the most superior aspect of the insertion of the digastric muscle.