006), but no difference was found between the RD and MD patients (P = 0.984). All three cohorts had similar selleck screening library intensive care unit lengths of stay (P = not significant). However, length of stay from operative procedure to discharge was significantly less in the RD and MD cohorts compared with conventional cohorts (P = 0.001). In all minimally invasive mitral valve operations the bleeding was controlled through the thoracotomy incision without the need for extension. However, there was no significant difference either in the percentage of patients receiving transfusions or the amount of blood products transfused [30] In addition, in a prospective, randomized trial, Dogan et al. [45] found a significant decrease in postoperative chest tube output in the miniVS group compared with the conventional group.

In a consecutive series of 41 patients undergoing either Port access (n = 21) or sternotomy (n = 20) mitral surgery, Glower et al. demonstrated no significant difference in chest tube drainage or transfusion requirements despite longer CPB times in the former [31]. Grossi et al. [39] found that a right thoracotomy was associated with 51% fewer blood products than a conventional sternotomy. In robotically assisted MVR, transfusion requirements are even lower (20% to 45% require transfusions) [11, 78]. Furthermore, 4 comparative studies found less blood loss: a minithoracotomy was used in 3 [26, 30, 31] and a parasternal approach was used in 1 [42]. Three of 10 studies found reduced transfusion requirements with a minimally invasive approach compared with conventional surgery [8, 34, 38] whereas the others showed no difference [31, 33, 42, 46, 65, 67, 77].

More convincing evidence came from a subsequent study by the same group that showed 13% fewer total transfusions with 1.8 fewer units of red blood cells using a minithoracotomy compared to a sternotomy [39]. Similar data from Cohn et al. confirm that patients undergoing minimally invasive valve surgery are transfused 1.8 units less compared to a conventional cohort [8]. Two of seven studies [56, 65] demonstrated a reduced need for reoperation for bleeding with a minimally invasive approach [38, 42, 44, 46]. Further, 5 studies showed a significant reduction in reoperations for bleeding with a minimally-invasive approach [32, 38, 42�C44, 49, 64].

The recent data from the Leipzig group on postoperative course included reoperation for bleeding in 69 patients (5.1%) [3]. 7. Atrial Fibrillation It has been suggested that a less traumatic surgical approach Batimastat would be a less potent trigger of postoperative AF. Nonetheless, 5 of 6 studies demonstrated that this is not the case [10, 30�C33, 46], and on meta-analysis of four eligible studies, there was no significant difference between minimally invasive and sternotomy approaches (539 patients, OR 0.86, 95% CI 0.59�C1.27, P = 0.45). Asher et al.