title: Impact of minimal access valve surgery on clinical outcomes: current best available evidence.
abstract: Recent years have seen a surge in the enthusiasm to perform minimal access valve surgery to reduce morbidity and improve clinical outcomes. Despite tremendous enthusiasm on the part of proponents of minimal access valve surgery, skepticism still exists about the actual impact of minimal access valve surgery in reducing postoperative morbidity. This review article attempts to evaluate the current best available evidence on the impact of minimal access valve surgery on postoperative clinical outcomes.
  
  
  METHODS
  The English language scientific literature was reviewed primarily by searching Medline from 1966 through February 2008 using PubMed interface. All blinded or unblinded randomized clinical trials, comparing minimal access valve surgery with conventional valve surgery through a full sternotomy, recruiting adult human patients undergoing valve repair, or replacement and reporting impact of these two approaches on at least 1 pertinent clinical or economic outcome, were included.
  
  
  RESULTS
  Current best available evidence from randomized clinical trials (Grade A, Level 1b) does not show any significant quantitative differences between minimal access valve surgery and conventional valve surgery for perioperative mortality or other primary outcome events of stroke, renal failure, or respiratory failure. There are small but statistically significant benefits for minimal access valve surgery for surrogate outcomes of ventilation time, intensive care unit stay, and total length of stay.
  
  
  CONCLUSIONS
  The published evidence is thin and a large multicenter randomized clinical trial with preferably standardization of minimal access valve surgery techniques and long term follow-up is required to validate the safety and efficacy of minimal access valve surgery.
authors.affiliation: Department of Cardiac Surgery, Harefield Hospital, London, UK. drrajashahzad@hotmail.com
authors.forename: Shahzad G
authors.initials: SG
authors.lastname: Raja
authors.forename: Manoraj
authors.initials: M
authors.lastname: Navaratnarajah
mesh_terms: D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D015996:Survival Rate; D016896:Treatment Outcome