Objective: To review current literature evidence on outcomes of minimally invasive double valve surgeries (MIS). Methods: A comprehensive electronic literature search was done from inception to 20th June 2020 identifying articles that discussed outcomes of minimally invasive approach in double valve surgeries either as a solo cohort or as comparative to conventional sternotomies. No limit was placed on time and place of publication and the evidence has been summarized in narrative manner within the manuscript. Results: Majority of current literature reported similar perioperative and clinical outcomes between MIS and conventional median sternotomy; except that MIS has better cosmetic effects and pain control. Nevertheless, minimal invasive techniques are associated with longer cardiopulmonary bypass and aortic cross-clamp times which may have impact on the reported outcomes and overall morbidity and mortality rates. Conclusion: Minimally invasive double valve surgery continues to develop, but scarcity in the literature suggests uptake is slow, possibly due to the learning curve associated with MIS. Many outcomes appear to be comparable to conventional sternotomy. There is need for larger, multi-center, and randomized trial to fully evaluate and establish the early, mid-and long-term morbidity and mortality rates associated with both techniques. K E Y W O R D S cardiac surgery, double valve, minimal access, minimal invasive 1 | INTRODUCTION Minimally invasive surgery (MIS) is a rapidly evolving technique for valvular pathologies, which has seen an increase in adoption over the last 24 years due to its popularization by Navia and Crosgrove. 1 The conventional median sternotomy (MS) has been the standard approach for decades, due to good exposure of the surgical field and more surgical experience with the technique, but MIS has gained more acceptance. The uptake has been slow in the past, possibly due to the learning curve reported and previous lack of established training programmes, but the outcomes reported have been at least as good, if not better, than MS. 2 In single valve surgery, MIS has been shown to have cosmetic, respiratory and blood product use advantages over MS, amongst many other benefits. 3,4 However, longer operation times have been reported for MIS. 5 In the USA, multiple valve surgery accounts for 3%-25% of all valve surgeries annually, 6 yet few studies have focussed on a minimally invasive approach for double valve surgery, with even less directly comparing MIS to MS. We reviewed the current literature to evaluate the outcomes of a minimally invasive approach to double valve surgery.
