Over the past two decades, minimally invasive cardiac surgery (MICS) has gained a significant place due to the emergence of innovative tools and improvements in surgical techniques, offering comparable efficacy and safety to traditional surgical methods. This review provides an overview of the history of MICS, its current state, and its prospects and highlights its advantages and limitations. Additionally, we highlight the growing trends and potential pathways for the expansion of MICS, underscoring the crucial role of technological advancements in shaping the future of this field. Recognizing the challenges, we strive to pave the way for further breakthroughs in minimally invasive cardiac procedures.

Background: Patch augmentation of the anterior mitral leaflet (AAML) is being used to treat functional mitral regurgitation (fMR) with the choice of patch material, however, still being a matter of debate. Therefore, the aim of this study was to determine the early‐ and 1‐year results of AAML for fMR. Methods: Between 2020 and 2022, 30 patients underwent AAML for Carpentier Type IIIb fMR using an untreated autologous pericardial patch in our institution. The mean age of the patients was 61.3 ± 19.3 years, and 16 patients (53.3%) were male. Early‐ and 1‐year results of mitral valve repair were assessed via clinical follow‐up including echocardiographic examination. Results: Twenty patients (66.7%) were operated on through a right mini‐thoracotomy and 10 patients (33.3%) via a median sternotomy, with 19 patients (63.3%) receiving a concomitant procedure. Three patients (10%) required postoperative mechanical circulatory support (MCS), with one of those patients (3.3%) deceasing due to multiple organ failure. Postoperative echocardiography showed that all patients (100%) had either no or mild MR. Freedom from moderate to severe MR was 100% ( n = 29) at discharge as well as after a 1.1 ± 0.17‐year follow‐up ( n = 26; with an additional three patients (10%) that deceased during the first postoperative year due to non–valve‐related causes). No patient required mitral valve‐related reoperation or intervention. Conclusions: AAML using an untreated autologous pericardial patch is a safe and reproducible surgical technique for fMR, with promising early results up to a 1‐year follow‐up. Further follow‐up is warranted to determine long‐term results especially with regard to the durability of mitral valve repair.

Patients with severely impaired left ventricular ejection fraction (LVEF) undergoing surgical coronary revascularization face elevated perioperative risk. We retrospectively analyzed all consecutive patients who underwent off-pump coronary artery bypass (OPCAB) surgery under prophylactic Impella 5.0/5.5 support at a single center between 2020 and 2023. The primary endpoint was 30-day all-cause mortality; secondary endpoints were the change in LVEF to discharge, early graft patency on computed tomography angiography, duration of support, and device- and access-related complications. Twenty-one patients were included. Median age was 63 years (IQR 59–74), 19 (90.5%) were male, and median EuroSCORE II was 10.8% (IQR 7.8–17.8). Median preoperative LVEF was 20% (IQR 20–28). Complete revascularization was achieved in all patients, and none required intraoperative conversion to cardiopulmonary bypass. Median duration of Impella support was 4 days (IQR 2–7). Median LVEF at discharge was 38% (IQR 34–40), with a median within-patient change of +16 percentage points (IQR 10–20). Predischarge computed tomography angiography showed early graft failure in one patient (4.8%). Two patients (9.5%) required postoperative escalation to veno-arterial extracorporeal membrane oxygenation, and 30-day mortality was 4.8% (n = 1). Impella 5.0/5.5-assisted OPCAB appears feasible in selected patients, with a complication profile that warrants further evaluation given the low number of patients enrolled. This uncontrolled series cannot establish a benefit attributable to Impella; prospective controlled evaluation is required.