Minimally invasive mitral valve surgery: Current evidence and best practice models

Objectives Minimally invasive mitral valve surgery (MI-MVS) has evolved into a widely adopted surgical strategy for the treatment of mitral valve disease. This narrative review summarizes, the importance of preoperative diagnostic work-ups, contemporary surgical techniques, perioperative management, learning curve considerations, and future perspectives of MI-MVS. Methods A review of currently available literature on MI-MVS was performed, focusing on direct-vision, video-assisted, fully endoscopic, and robotic-assisted approaches. Best practice models regarding preoperative imaging, cannulation strategies, myocardial protection, mitral valve repair techniques, perioperative management, and Enhanced Recovery After Surgery (ERAS) protocols as well as important clinical outcome measures are discussed. Results MI-MVS provides reduced surgical trauma, shorter hospitalization, lower infection rates, and a faster recovery. Video-assisted right mini-thoracotomy remains the most commonly adopted approach, whereas fully endoscopic and robotic-assisted techniques continue to expand. Routine preoperative contrast-enhanced computed tomography improves patient selection as well as procedural planning and reduces the risk of stroke. Careful patient selection and structured mentorship are essential to overcome the learning curve. Conclusions MI-MVS has become an established and effective treatment strategy for mitral valve disease in experienced centers. Ongoing advances in surgical technology, imaging tools, ERAS protocols, and robotic platforms are expected to further expand its global adoption. Standardized training pathways, careful patient selection, and experienced institutional mentorship remain critical for optimizing clinical outcomes.