Operative outcomes following robotic-assisted and conventional minimally invasive mitral valve surgery: A meta-analysis of propensity-matched studies.

Background: This study compares our experience of early outcome of mitral valve surgery (MVS) after minimally invasive (MI) versus standard median sternotomy (SMS) approach. Objective: Minimal invasive mitral valve surgery (MIMVS) aims to avoid complications of SMS like; bleeding, postoperative pain, and sternal wound infection. It provides better cosmesis and early recovery. The aim of this study is to evaluate early clinical outcome of MIMVS. Patient and Method: It is prospective comparative cohort study in adult patients with mitral valve disease who perform MVS using either MI or SMS. From January 2020 to December 2021, early outcome of MVS between [120 patients] MI group through right mini-thoracotomy (RMT) with CPB peripheral cannulation and [120 patients] SMS group are compared. Result: Females are more in MIMVS (80%). ACC and CPB time are longer in MIMVS than SMS (118±15.5 vs 74.4±32.3, 155±28.5 vs 115±48.8). Tricuspid repair and left atrial appendage (LAA) occlusion are performed only in SMS. Blood loss is lesser in MIMVS (250 ± 60.6 ml) than in SMS (550 ± 230 ml). Blood transfusion required (0.1 ± 0.53) in MIMVS, and (0.9 ± 0.7) in SMS. Re-exploration for bleeding is required in (4) cases of SMS. Mechanical ventilation time is shorter in MIMVS (6.4 ± 1.3) than in SMS (12.4 ± 6.8). ICU duration and hospital stay are shorter in MIMVS than SMS (2±0.4 vs 3.5±1.3, 7.2±1.3 vs 12±0.5). Wound infections present in (20) cases of SMS. Spirometric studies in MIMVS reveal better postoperative pulmonary functions than SMS group. Pain Visual Analog Score at discharge is better in MIMVS (1.4 ± 0.6) than in SMS (8.5 ± 1.5). There is no hospital mortality in both groups. Conclusion: Minimal invasive mitral valve surgery is a safe procedure and improves cosmesis and patient’s satisfaction.

Background: Minimally invasive mitral valve surgery (MiMVS), particularly via right mini-thoracotomy, has gained popularity as an alternative to median sternotomy, potentially reducing surgical trauma and recovery time. However, recent data on its surgical outcomes remain limited. To provide updated insights while minimizing selection bias, we analyzed elective patients undergoing mitral valve surgery, comparing MiMVS and sternotomy in terms of survival, operative times, and perioperative complications.Methods: We conducted a single-center retrospective cohort study that included patients who underwent mitral valve surgery between 2015 and 2024. Patients were stratified into MiMVS or sternotomy groups. Kaplan-Meier survival curves and log-rank tests assessed survival, while propensity score matching (PSM) minimized selection bias.Results: Among 422 patients (319 MiMVS, 103 sternotomy), the MiMVS group had a shorter hospital stay (5.0 vs. 8.0 days, p < 0.01) and lower postoperative bleeding (3.9% vs. 9%). Median cross-clamp and cardiopulmonary bypass (CPB) times were shorter in MiMVS (76 vs. 94 min, p < 0.01; and 114 vs. 140 min, p < 0.01, respectively). Survival analysis showed no significant difference between groups (log-rank p = 0.07) after PSM. The adjusted hazard ratio for mortality in MiMVS versus sternotomy was 0.30 (95% CI: 0.08-1.12, p = 0.07). However, mitral replacement was associated with a significantly higher mortality risk than mitral repair (HR 5.22, 95% CI: 1.26-21.61, p = 0.04). In-hospital mortality was comparable (1.9% for sternotomy vs. 0.6% for MiMVS, p = 0.25). Reoperation rates at five and 10 years were lower in MiMVS (1.7% vs. 2.1% at five years and 1.7% vs. 3.2% at 10 years).Conclusions: While MiMVS offers advantages such as shorter hospital stays and lower postoperative bleeding rates, no statistically significant difference in overall survival was found compared to sternotomy. However, a trend toward improved survival with MiMVS was observed. Notably, mitral valve replacement was associated with a significantly higher mortality risk than mitral repair, emphasizing the importance of prioritizing repair whenever feasible.

The aim of this study was to evaluate whether the addition of concomitant tricuspid valve surgery (TVS) negatively impacted operative outcomes of minimally invasive mitral valve surgery (MIMVS). Patients undergoing MIMVS via a port-access right minithoracotomy between 2002 and 2014 at a single institution were reviewed. Patients were primarily stratified by those undergoing isolated MIMVS versus MIMVS+TVS. Propensity-matched cohorts were generated. Operative outcomes were compared between the propensity-matched cohorts and included operative mortality, complications, and length of hospital stay. A total of 1,158 patients underwent MIMVS via port-access right minithoracotomy. The majority of cases were elective (93%; n = 1,071) and 148 (13%) underwent concomitant MIMVS + TVS. Patients undergoing MIMVS + TVS were at higher risk at baseline. After propensity-matching, there were 119 isolated MIMVS and 119 MIMVS + TVS patients that were well matched with respect to all baseline variables. Cardiopulmonary bypass (148 ± 54 minutes versus 175 ± 54 minutes, P < 0.001) and aortic occlusion times (105 ± 36 minutes versus 128 ± 40 minutes, P < 0.001) were longer in the MIMVS + TVS group. Operative mortality was comparable (3% isolated MIMVS versus 4% for MIMVS + TVS; P = 0.73). Permanent pacemakers were required less frequently in the isolated MIMVS group (1% versus 6%; P = 0.03). All other complication rates were similar. Median length of hospital stay (7 versus 8 days; P = 0.13) and discharge-to-home rates (89% versus 94%; P = 0.15) were comparable. Despite longer operative times, minimally invasive TVS performed concomitantly with MIMVS has similar operative outcomes with the exception of a higher pacemaker rate when compared with isolated MIMVS.

Mitral valve surgery (MVS) has continuously evolved over the past decades. Indications, repair techniques and surgical approaches represent the most important revolutions of the MVS. Mitral valve replacement has been considered the treatment of choice for mitral valve disease for many decades. Despite initial criticisms, repair is now considered the standard of care of most mitral valve diseases as a number of studies have demonstrated its superiority over replacement, in terms of mortality, morbidities and long-term results, while reducing the risk of infective endocarditis, thromboembolism events and bleeding complications related to anticoagulation [1, 2]. Median sternotomy is the common surgical approach for heart surgery. It provides excellent exposure to the heart and great vessels, allows central arterial and venous cannulation for cardiopulmonary bypass and guarantees a good myocardial protection. The operation can be performed precisely and expeditiously and if complications occur, the surgeon may have direct access to the heart. MVS has been performed through median sternotomy for more than 30 years and the clinical outcomes have significantly improved in the past years, despite gradual increase in patient age and overall risk profile. Recent data reported from STS database showed an overall operative mortality for isolated mitral valve repair of 1.2% and a 0.6% in asymptomatic patients [3]. Freedom from reoperation is very high in the setting of degenerative mitral valve disease, as Carpentier et al. have demonstrated a freedom from reoperation of 95% at 15 years [4]. Despite these excellent results, less-invasive procedures have been developed as an alternative to the conventional technique to reduce the surgical trauma and preserve the same quality, safety and efficacy of the full sternotomy approach. The term ‘minimally invasive’ refers to a small chest wall incision that does not include a full sternotomy [5]. The most common minimally invasive MVS (MIMVS) approach is the right minithoracotomy, followed by the lower ministernotomy. Potential benefits of the MIMVS approach are less surgical trauma and postoperative pain, better respiratory function due to the preservation of the sternum, faster recovery and better cosmesis. Compared with conventional procedure, several meta-analyses have shown that MIMVS is associated with low mortality and excellent postoperative outcomes [6, 7]. Specifically, MIMVS has the advantage of reducing bleeding, blood product transfusion, atrial fibrillation, sternal wound infection, ventilation times, intensive care unit, hospital length of stay as well as to reduce the time to return to normal activity. These benefits are even more evident in the setting of redo surgery [8]. At the last EACTS meeting held in Milan, we presented our 10-year experience on over 1600 patients undergoing MIMVS for any mitral valve disease, showing an overall mortality rate of 1.1%, a 95% rate of mitral valve repair in the setting of degenerative mitral valve disease and a freedom from reoperation of 94% at 10 years (Fig. 1). Despite these excellent results, many criticisms still remain regarding MIMVS. Traditionalists have claimed that MIMVS is technically more complex, requires dedicated instruments and reduces the rate of mitral valve repair. Despite the learning curve (generally at least 25 cases), results from experienced centres have confirmed that right minithoracotomy or ministernotomy approach is a safe and reproducible technique, can be taught successfully to cardiac trainees and enable excellent repairs, even in the setting of mitral valve Barlow disease [9–11]. A second criticism are related to morbidities associated with peripheral arterial cannulation in terms of neurological events, pseudoaneurysm and wound infections. In a meta-analysis of over 12 000 patients, Cheng et al. concluded that MIMVS was associated with higher incidence of stroke, aortic dissection and groin complications and phrenic nerve palsy [7]. We previously highlighted the importance of antegrade perfusion and the use of a CO2 line in reducing neurological complications and postoperative delirium [12]. Our preference is the direct aortic cannulation, which allows a more direct and physiological flow to the brain and reduces morbidities related to the groin cannulation. In addition, the use of direct aortic clamping in favour of balloon endoclamp has definitively reduced the rate of aortic dissection. To avoid phrenic nerve palsy, it is mandatory to identify the phrenic nerve after thoracotomy and the pericardium should be opened at least 3–4 cm above it. Third criticism is related to the cost of the surgical instrumentations and optical devices. Although these devices are more expensive and are not required in standard sternotomy, the low rate of complications and the faster recovery associated with the minimally invasive procedures

BackgroundOver the past decade, minimally invasive mitral valve surgery (MIMVS) has grown in popularity. Less invasive approaches to mitral valve surgery are increasingly used for improved cosmesis. We sought to compare these minimally invasive approaches fairly with conventional full sternotomy approaches by using propensity-matching methods.MethodsFrom January 2011 to January 2017, a total of 1120 isolated mitral valve operations were performed at our institution. Data were retrospectively collected on all patients, and a logistic regression model was created to predict selection to a minimally invasive versus conventional sternotomy approach. Propensity scores were then generated based on the regression model and matched pairs created using 1:1 nearest neighbor matching. There were 165 matched pairs in the analysis (sternotomy, n = 165;MIMVS, n = 165). Clinical outcomes included bypass and cross-clamp time, length of hospitalization, morbidity, and mortality. Patient details and follow-up outcomes were compared using multivariate, and Kaplan–Meier analyses.ResultsThe minimally invasive approach led to slightly longer cardiopulmonary bypass time (99 ± 25 vs 88 ± 17 min, p <0.001), and cross-clamp time (65 ± 13 vs 49 ± 11 min, p<0.001). Overall, no significant differences existed among major in-hospital complications between groups. There were no differences between the matched groups in 30-day mortality (1.2% vs 0.6%, p >0.05). However, Chest tube drainage was lower at 6 and 24 h after a minimally invasive approach (30 ± 5 mL) and 120 ± 20 mL than after conventional sternotomy 175 ± 50 mL and 400 ± 150 mL at these times (p < 0.001). Transfusion was less frequent after minimally invasive surgery than after conventional surgery (15.7% vs 40.6%, p < 0.001). Patients undergoing minimally invasive surgery spent less time on ventilation support (6.2 ± 1.1 h vs 10.4 ± 2.7, p < 0.001). The multivariable regression analysis showed the full sternotomy was an independent risk factor for the propensity-adjusted likelihood of postoperative transfusion, re-exploration for bleeding, and postoperative ventilation support (p < 0.05). But the duration of cardiopulmonary bypass time was not an independent risk factor. The mean duration of survival follow-up was 4.4 ± 1.2 years. However, comparison of survival curves between the two groups revealed no significant difference (P = 0.203). With regard to freedom from valve-related morbidity, there was no significant difference between groups (P = 0 .574).ConclusionWithin that portion of the spectrum of mitral valve surgery in which propensity matching was possible, minimally invasive mitral valve surgery has cosmetic, blood product use, and respiratory advantages over conventional surgery, and no apparent detriments. However, minimally invasive mitral valve surgery required a slightly longer cardiopulmonary bypass time and cross-clamp time. Minimally invasive mitral valve surgery represents a safe and effective surgical technique that we believe should be used more routinely in the surgical management of mitral valve disease. MIMVS provides equally durable midterm results as the standard sternotomy approach.

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether minimally invasive mitral valve surgery (MIMVS) should be considered as an alternative to conventional sternotomy (ST) in high-risk patients. Eighty-six papers were found by a systematic search, of which seven were comparing MIMVS with ST in high-risk patients and addressing the clinical question. Five were retrospective observational and two were propensity-matched studies. One paper included patients with infective endocarditis, one with preoperative renal failure, two papers the elderly, three papers compared redo surgery. Author, journal, date, patient group, country of publication, relevant outcomes, results and study weaknesses were tabulated. In total, these seven studies included 1254 high-risk patients (n = 523 MIMVS, 731 ST) undergoing mitral valve surgery, either repair or replacement. End-points of interest were mortality, intraoperative and postoperative outcomes and survival. With regard to MIMVS group, in-hospital mortality was lower in three studies and with no statistically significant differences in the other four; cardiopulmonary bypass (CPB) times were similar in one study, but were longer in three other studies. MIMVS led to reduced postoperative complications in six studies (one did not report complications); among studies that included late mortality, one reported better survival in the MIMVS group whereas the other two did not report differences. We conclude that, although MIMVS may be associated with longer CPB and cross-clamp times, it is at least as safe as ST in terms of both mortality and morbidity, in these high-risk groups.

Although the incidence of mitral valve (MV) surgery after previous open-heart surgery is increasing, there is no consensus regarding the optimal surgical approach. Reoperative MV surgery is most commonly performed via sternotomy (ST). We sought to determine whether minimally-invasive (MIS) reoperative MV surgery is safe and feasible. All patients with a history of ST undergoing MV surgery with or without concomitant tricuspid or atrial fibrillation surgery at a single institution from 2007 to 2018 were retrospectively reviewed. ST and MIS approaches were compared using propensity-matched analysis. The coprimary endpoints were operative mortality and 1-year survival, and secondary endpoints were operative complications and length of stay. A total of 305 isolated MV reoperations were performed: 199 (65%) MIS and 106 (35%) ST. MIS patients were older than ST patients (71 [63, 76.5] vs. 66 [56, 72] years, p < .01), more likely to have undergone prior coronary artery bypass grafting (57% vs. 27%, p < .01), and less likely to have had prior valve surgery (55% vs. 78%, p < .01). In unmatched comparisons, operative mortality was significantly lower among MIS patients (3.0% vs. 8.5%, p = .04), but 1-year mortality was similar (14.4% vs. 15.6%, p = .8). After propensity matching, 88 pairs had excellent balance across baseline characteristics. Mortality was similar among MIS and ST patients at 30 days (3.4% vs. 8%, p = .19) and 1 year (15.9% vs. 16.5%, p = .9). RBC and fresh frozen plasma transfusions were significantly lower in the MIS group (p < .01). A minimally invasive approach is a safe alternative in patients with prior ST undergoing MV surgery.

BackgroundThe heightened morbidity and mortality associated with repeat cardiac surgery are well documented. Redo median sternotomy (MS) and minimally invasive valve surgery are options for patients with prior cardiac surgery who require mitral valve surgery (MVS). We conducted a systematic review and meta-analysis comparing the outcomes of redo MS and minimally invasive MVS (MIMVS) in this population.MethodsWe searched PubMed, EMBASE, and Scopus for studies comparing outcomes of redo MS and MIMVS for MVS. To calculate risk ratios (RRs) for binary outcomes and weighted mean differences (MDs) for continuous data, we employed a random-effects model.ResultsWe included 12 retrospective observational studies, comprising 4157 participants (675 for MIMVS; 3482 for redo MS). Reductions in mortality (RR, 0.54; 95% confidence interval [CI], 0.37–0.80), length of hospital stay (MD, −4.23; 95% CI, −5.77 to −2.68), length of intensive care unit (ICU) stay (MD, −2.02; 95% CI, −3.17 to −0.88), and new-onset acute kidney injury (AKI) risk (odds ratio, 0.34; 95% CI, 0.19 to 0.61) were statistically significant and favored MIMVS (p<0.05). No significant differences were observed in aortic cross-clamp time, cardiopulmonary bypass time, or risk of perioperative stroke, new-onset atrial fibrillation, surgical site infection, or reoperation for bleeding (p>0.05).ConclusionThe current literature, which primarily consists of retrospective comparisons, underscores certain benefits of MIMVS over redo MS. These include decreased mortality, shorter hospital and ICU stays, and reduced AKI risk. Given the lack of high-quality evidence, prospective randomized control trials with adequate power are necessary to investigate long-term outcomes.

2. Minimally invasive mitral valve surgery why do you take the risks?

Background: Minimal invasive mitral valve surgery gained wide acceptance. However, criticism continuous about its ability to replace the conventional full sternotomy technique.Aim of the work: The study aimed to compare between the full sternotomy and less invasive approaches for mitral valve surgery.Patients and Methods: The study recruited 100 patients. They were allocated to one of two equal groups [the traditional and minimal invasive approach]. All patients were thoroughly evaluated by history taking, physical examination, laboratory and ancillary radiological investigations. Assessment included incision length, weaning events, aortic cross clamp time, total bypass and operative times, rate of conversion from minimally invasive technique to full sternotomy. In surgical intensive care unit, ventilation hours, post-operative pain and need for analgesia, re-exploration for bleeding, blood loss and blood transfusion, and any complications were documented.Results: Preoperative New York Heart Association [NYHA] class was significantly different between groups A and B. But, no significant difference was reported for patient demographic or preoperative data. The incision length and cross clamp time was shorter in A than B group [6.56±1.88 cm, 61.78±35.91 minutes’ vs 12.54±1.78 cm, and 78.08±36.24 minutes, respectively]. Otherwise, the cannulation, bypass, operative times were significantly longer among group A. The ventilation, ICU stay, hospital stay, bleeding, serum creatinine and pain scores were significantly lower among group A. the postoperative events were comparable between both groups with slight increase of neurological events in A group [3 cases] than B group [2 cases]. At 6 months, both groups yielded non-significant difference, regardless of better outcome at direct postoperative time.Conclusion: Minimal invasive mitral valve surgery had a good short and mid-term outcome as the conventional sternotomy approach. It could replace the conventional approach as a gold-standard for mitral valve surgery.

The evidence underlying the efficacy and safety of minimally invasive mitral valve surgery (MIMVS) is inconclusive. We conducted a meta-analysis to evaluate whether MIMVS improves clinical outcomes compared with conventional sternotomy. We searched MEDLINE (via PubMed), Embase, the Cochrane Library, and ClinicalTrials.gov from inception to January 2024 for all randomised controlled trials (RCTs), comparing MIMVS with conventional mitral valve surgery. RevMan 5.4 was used to analyse the data with risk ratio (RR) and mean difference (MD) as the effect measures. Eight studies reporting data on 7 RCTs were included in our review. There was no significant difference in all-cause mortality, the number of patients requiring blood product transfusion, and the change from baseline in the SF-36 physical function scores between the MIMVS and conventional sternotomy groups. MIMVS reduced the length of hospital stay (MD -2.02 days, 95% CI: -3.66, -0.39) but did not affect the length of ICU stay, re-operation for bleeding, and the incidence of renal injury, wound infection, neurological events, and postoperative moderate or severe mitral regurgitation. MIMVS was associated with a trend toward lower postoperative pain scores (MD -1.06; 95% CI: -3.96 to 0.75). MIMVS reduced the number of days spent in the hospital and showed a trend toward lower postoperative pain scores, but it did not decrease the risk of all-cause mortality or the number of patients needing blood product transfusions. Further large-scale RCTs are required to inform definitive conclusions, particularly with regard to quality-of-life outcomes investigating functional recovery. PROSPERO (CRD42023482122).

Multiple studies have suggested that women have worse outcomes than men following mitral valve (MV) surgery-most of those studies reported on conventional sternotomy (CS) MV surgery. Therefore, we aimed to explore whether or not the minimally invasive mitral valve surgery (MIMVS) approach might mitigate a worse survival in women following MV surgery. We identified patients with isolated primary MV operations with or without tricuspid valve repair performed between 2007 and 2019. Patients were propensity score-matched across the MIMVS and CS surgical approaches. Sex was excluded from the matching process to discern whether female patients had a different likelihood of receiving minimally invasive surgery than males. A Cox proportional hazards model was fitted in the matched cohort and adjusted for the imbalance in baseline characteristics using the propensity score. Of 956 patients (417 MIMVS, 539 CS; 424 females), the matched set comprised 342 pairs (684 patients; 296 females) of patients who were well balanced across MIMVS and CS groups with regard to preoperative clinical characteristics. We observed a 47/53% female/male ratio in the CS group and a 39/61% in the MIMVS group, P = 0.054. In both matched groups, women were older than males. A Cox model adjusted for propensity scores showed no survival difference with sex, surgical type or interaction. Women present to the surgical team at an older age. They appear less likely to be considered for a MIMVS approach than men. Neither sex nor surgical approach was associated with worse survival in a matched sample.

Minimally invasive mitral valve surgery (MIMVS) has become a standard technique to perform mitral valve surgery in many cardiac centers. However, there remains a question regarding when MIMVS should not be performed due to an increased surgical risk. Consequently, expert surgeons were surveyed regarding their opinions on patient factors, mitral valve pathology and surgical skills in MIMVS. Surgeons experienced in MIMVS were identified through an electronic search of the literature. A link to an online survey platform was sent to all surgeons, as well as two follow-up reminders. Survey responses were then submitted to a central database and analyzed. The survey was completed by 20 surgeons. Overall results were not uniform with regard to contraindications to performing MIMVS. Some respondents do not consider left atrial enlargement (95% of surgeons), complexity of surgery (75%), age (70%), aortic calcification (70%), EuroSCORE (60%), left ventricular ejection fraction (55%), or obesity (50%) to be contraindication to surgery. Ninety percent of respondents believe more than 20 cases are required to gain familiarity with the procedure, while 85% believe at least one MIMVS case needs to be performed per week to maintain proficiency. Eighty percent recommend establishment of multi-institutional databases and standardized surgical mentoring courses, while 75% believe MIMVS should be incorporated into current training programs for trainees. These results suggest that MIMVS has been accepted as a treatment option for patients with mitral valve pathologies according the expert panel. Initial training and continuing practice is recommended to maintain proficiency, as well as further research and formalization of training programs.

Atrial fibrillation (AF) occurs frequently in patients with mitral valve disease. Results of cryoablation concomitant with either minimally invasive video-assisted [minimally invasive mitral valve surgery (MIMVS)] or with robotic-assisted (RMV) mitral valve surgery have previously been separately reported. However, there are up-to-date no studies comparing the two procedures in terms of safety, efficacy, and mid-term follow-up. Between January 2017 and March 2022, 294 patients underwent MIMVS, and 187 patients underwent RMV at our institution. After 1:1 propensity score matching using 22 preoperative variables, the study included 104 patients. Group 1 (MIMVS) included 52 patients operated on between 2017-2022 using a minimally invasive video-assisted right-sided mini-thoracotomy. Group 2 (RMV) included 52 patients operated on between 2019-2021 using a robotic-assisted approach. Early and mid-term outcomes were assessed, including maintenance of sinus rhythm. Follow-up was 100% complete at a median follow-up of 2 years. For the entire propensity matched cohort, the median EuroSCORE II was 3.14 [interquartile range (IQR), 1.93-4.99], the median age was 68 (IQR, 61-74) years, and two thirds of the patients were male. Most (72.1%) underwent mitral valve surgery, and 26.9% had an additional tricuspid procedure. Only four patients underwent mitral valve replacement (3.8%). The majority (87.5%) received a left-sided atrial Maze and 12.5% a bi-atrial Maze. The left atrial appendage was occluded in 72.1% cases. Overall, there were no significant differences between the two propensity matched groups in baseline demographics or intra-operative characteristics. Similarly, there were no significant differences in the post-operative short and mid-term outcomes between the two groups. There were no in-hospital or 30-day deaths. At the mid-term survival was similar between groups, log-rank test P=0.056. Maintenance of sinus rhythm at follow-up was 76%. Mitral or double valve repair with concomitant cryoablation can be safely performed with either a MIMVS or RMV approach. Both methods demonstrated outstanding early and mid-term outcomes.

BackgroundSexual dysfunction after cardiac surgery can seriously affect patients’ quality of life, but the impact of cardiac surgery on sexual function has long been neglected. Compared with conventional cardiac surgery, minimally invasive cardiac surgery has the advantages of aesthetic appearance and no disruption of the sternal structure, which can greatly improve the patient's quality of life. However, studies focusing on the effects of minimally invasive mitral valve surgery (MIMVS) on sexual function have not been reported. The objective of this research was to investigate the effects of totally endoscopic mitral valve surgery on health-related quality of life and sexual function in male patients and to provide possible recommendations.MethodsPatients who underwent median sternotomy or totally endoscopic mitral valve surgery at our institution from January 2019 to December 2020 were selected using an electronic medical record system. Data were collected by questionnaires, including the MOS 36-item short-form health survey and the International Erectile Function Questionnaire.ResultsThere were 156 male patients who participated in our study. Of these, 112 patients completed all questionnaires. Forty-five patients (40.18%) developed postoperative sexual dysfunction, including 15 patients (29.41%) in the MIMVS group and 30 patients (49.18%) in the conventional MVS group, indicating that the incidence of sexual dysfunction could be reduced by MIMVS and that the MIMVS group scored better on the International Erectile Function Questionnaire (P < 0.05). On the evaluation of health-related quality of life, the MIMVS group scored better than the MVS group on the mental health and bodily pain subscales of the MOS 36-item short-form health survey. In addition, our study showed that postoperative sexual dysfunction was associated with physical functioning and mental health.ConclusionsIn our study, totally endoscopic mitral valve surgery had less adverse effects on sexual function in male patients than conventional mitral valve surgery. In terms of health-related quality of life, totally endoscopic mitral valve surgery was superior to conventional surgery. Patients who opt for totally endoscopic mitral valve surgery may have a more satisfying and healthier sexual life than those who undergo conventional mitral valve surgery.