When Culture Dictates Practice: Adoption of Minimally Invasive Mitral Valve Surgery

In adults, mitral regurgitation is the second most common indication for valve surgery following aortic stenosis. The developments in mitral valve surgery have further enabled improved safety and outcomes for patients, leading to a recent shift to intervene earlier for asymptomatic severe degenerative mitral regurgitation with a high likelihood of repair.¹ In parallel with these advances in conventional sternotomy approaches during the past decades, minimally invasive techniques have been introduced and refined in mitral valve surgery. These techniques, although presenting with potentially prolonged cardiopulmonary bypass and cross-clamp times, have consistently demonstrated shorter hospital lengths of stay, decreased blood utilization, lower risk of atrial fibrillation, faster recovery, and lower overall costs with comparable outcomes as open surgery.^2,3 Additionally, valve repair rates are found to be higher in minimally invasive mitral valve surgery compared with conventional sternotomy.³ Nevertheless, despite the important role of minimally invasive techniques in optimizing patient care and cost-effectiveness, adoption varies widely across the world.

Here, we seek to describe reasons underlying the variation in uptake of minimally invasive techniques in mitral valve surgery and describe opportunities to increase the adoption by surgeons and programs.