Minimally Invasive Cardiac Valve Surgery During The COVID-19 Pandemic: To Do or Not To Do, That Is The Question
Minimally invasive cardiac surgery (MICS) is now an established technique in many centres across Europe and the USA. Studies, mostly observational, have shown potential benefits in terms of increased patient satisfaction, reduced wound infections, improved postoperative respiratory function, faster recovery, reduced blood transfusions and improved cost-effectiveness with MICS when compared to conventional approaches. However, recently published randomised trials comparing mini-sternotomy aortic valve replacement (AVR) with conventional AVR have shown no clear benefit. Randomised data looking at the potential benefits of mini-thoracotomy AVR are still awaited; however, some observational studies have shown that this holds a promise. When it comes to minimally invasive mitral valve repair, the results of a critical randomised controlled trial are still awaited. Nevertheless, there is a general agreement in the literature, that hard end-points such as short- and long-term survival after MICS are the same with the two techniques. From our experience, MICS remains a highly desirable choice for our patients and cardiology colleagues that are in the search for less invasive strategies.
Like any other surgical speciality, the COVID-19 pandemic has also profoundly affected cardiac surgical practice with activity halted transiently in order to maximise the availability of intensive care beds, ventilators and staff for patients affected by acute respiratory distress. At present, cardiac services are gradually aiming to return to the pre-COVID state, as there is a steady decline in the number of new cases and COVID-related deaths leading to increased relaxation of social distancing. However, this could be severely hampered if a second COVID peak occurs, which would further delay treatment and significantly contribute to valve-related mortality of patients on the MICS waiting list.
During these unprecedented times, due to factors related to staff, experience, equipment and potential infection, we herein reflect if we should be doing MICS.
