Background and Objectives: Minimally invasive valve surgery (MIVS), integrated within enhanced recovery after surgery (ERAS) programs, is a pivotal advancement in modern cardiac surgery, aiming to reduce perioperative morbidity and accelerate recovery. This systematic review analyzes the integration of ERAS components into MIVS programs and evaluates their impact on perioperative outcomes and patient recovery. Materials and Methods: A systematic search of PubMed/Medline, conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, identified studies on ERAS in MIVS patients. Coronary and robotic surgery were excluded to prioritize widely adopted minimally invasive valve methods. Studies were included if they applied ERAS protocols primarily to MIVS patients, with at least five participants per study. Data on study characteristics, ERAS components, and patient outcomes were extracted for analysis. Results: Eight studies met the inclusion criteria, encompassing 1287 MIVS patients (842 ERAS, 445 non-ERAS). ERAS protocols in MIVS were heterogeneous, with studies implementing 9 to 18 of 24 ERAS measures recommended by the ERAS consensus guideline, reflecting local hospital practices and resource availability. Common elements include patient education and multidisciplinary teams, early extubation followed by mobilization, multimodal opioid-sparing pain management, and timely removal of invasive lines. Despite protocol variability, these programs were associated with reduced morbidity, shorter hospital stays (intensive care unit-stay reductions of 4–20 h to complete omission, and total length of stay by ≥1 day), and cost savings of up to EUR 1909.8 per patient without compromising safety. Conclusions: ERAS protocols and MIVS synergistically enhance recovery and reduce the length of hospital stay. Standardizing ERAS protocols for MVS could amplify these benefits and broaden adoption.

OBJECTIVES: This study investigates our enhanced recovery after minimally invasive cardiac surgery program “enhanced recovery after minimally invasive cardiac surgery” (ERMICS) following a ‘Zero ICU’ concept compared to standard-of-care treatment in terms of safety and clinical efficacy. METHODS: All patients who underwent minimally invasive mitral valve surgery for primary severe mitral valve regurgitation between 2021 and 2023 were included. Propensity score matching (2:1) was performed between patients who received standard-of-care treatment and those who underwent ERMICS. Patients treated with the ERMICS approach were transferred to the peripheral ward instead of the intensive care unit on the day of surgery (Zero ICU). Separate primary end-points were safety (mortality, stroke), postoperative ventilation time and hospital length of stay. RESULTS: A total of 611 patients (566 standard of care vs 45 ERMICS) were included in the study. After 2:1 matching, the cohort comprised 135 patients (90 standard of care vs 45 ERMICS) and were well balanced in terms of pre- and intraoperative variables. Thirty-day mortality was 0% in both groups. Postoperative ventilation time [P = 0.018, odds ratio (OR) < 0.01, confidence interval (CI) < 0.001], postoperative pain (P = 0.005, OR = 0.36, CI 0.18–0.74) and hospital length of stay (P = 0.049, OR = 0.28, CI 0.08–0.98) was significantly lower in ERMICS patients, while postoperative complications did not differ. CONCLUSIONS: Our ERMICS ‘Zero ICU’ concept is safe and leads to significantly shorter postoperative ventilation time and hospital length of stay for patients undergoing minimally invasive mitral valve surgery for primary severe mitral valve regurgitation.