Since its early days, cardiac surgery has typically involved large incisions with complete access to the heart and the great vessels. After the popularization of the minimally invasive techniques in general surgery, cardiac surgeons began to experiment with minimal access techniques in the early 1990s. Although the goals of minimally invasive cardiac surgery (MICS) are fairly well established as decreased pain, shorter hospital stay, accelerated recuperation, improved cosmesis, and cost effectiveness, a strict definition of minimally invasive cardiac surgery has been more elusive. Minimally invasive cardiac surgery started with mitral valve procedures and then gradually expanded towards other valve procedures, coronary artery bypass grafting, and various types of simple congenital heart procedures. In this paper, the authors attempt to focus on the evolution, techniques, results, and the future perspective of minimally invasive mitral valve surgery (MIMVS). 1. Introduction Minimally invasive mitral valve surgery (MIMVS) does not refer to a single approach but rather to a collection of new techniques and operation-specific technologies. These include enhanced visualization and instrumentation systems as well as modified perfusion methods, all directed toward minimizing surgical trauma by reducing the incision size [1]. 2. History and Evolution of MIMVS The first successful cardiac operation was performed on September 7, 1896, in Frankfurt, Germany, by Rehn [2]. The first successful cardiac valve operation was performed in 1912 by Tuffier [3] and the first successful mitral valve (MV) operation in 1923 by Cutler and Levine [4]. In 1956, Lillehei et al. repaired multiple valvular lesions through a right thoracotomy using cardiopulmonary bypass (CPB) [5]. The subsequent years have seen a glorious phase of mitral valve surgery with full sternotomy and use of conventional cardiopulmonary bypass techniques. This phase also witnessed the development of various valvular prostheses and mitral valve repair techniques. In the 1990s, the success of laparoscopic operations in general surgery renewed an interest in minimally invasive approaches for cardiac surgery. Navia and Cosgrove [6] and Cohn et al. [7] performed the first minimally invasive valve operations (via the right parasternal and transsternal approaches). These authors have shown that small incision mitral valve surgery can be conducted safely with equivalent outcomes. Carpentier et al. [8] in February of 1996 performed the first video-assisted mitral valve repair (MVR) through a mini thoracotomy using
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