Contemporary advances in Minimally Invasive Cardiac Surgery: Clinical Outcomes, Challenges, and Future Perspectives – A Systematic Review
Anak Agung Ketut Lanang Ari Mayun1, Ni Nyoman Hita Girindra Wardani2*, Putu Gede Ananda Krishna Dipayana3
Abstract
Minimally invasive cardiac surgery (MICS) has increasingly emerged as an alternative to conventional median sternotomy with the aim of reducing surgical trauma while maintaining procedural safety and effectiveness. Advances in surgical techniques, perioperative management, and robotic technology have expanded the indications of MICS across a wide spectrum of cardiac procedures, particularly mitral and aortic valve surgery. Nevertheless, variability in reported outcomes, implementation challenges, and resource requirements highlights the need for a comprehensive synthesis of contemporary evidence. This systematic review aimed to evaluate recent international literature on the clinical outcomes of minimally invasive cardiac surgery, identify key challenges associated with its implementation, and explore future perspectives in modern cardiac surgical practice. A systematic literature search was conducted in PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library for studies published between January 2020 and January 2026. Randomized controlled trials and observational studies involving adult patients undergoing minimally invasive cardiac surgery were included, with study selection and reporting conducted in accordance with PRISMA 2020 guidelines. Data on perioperative outcomes, postoperative recovery, and implementation-related factors were extracted and synthesized narratively, while risk of bias was assessed using RoB 2.0 and ROBINS-I tools. Eighteen studies met the inclusion criteria. Across predominantly mitral and aortic valve procedures, MICS demonstrated perioperative and 30-day mortality rates comparable to conventional sternotomy. Minimally invasive approaches were consistently associated with reduced blood loss, lower transfusion requirements, shorter intensive care unit and hospital stays, and faster postoperative recovery. However, implementation challenges included learning curve effects, longer operative times during early adoption, higher initial costs, and the need for specialized multidisciplinary teams. Robotic-assisted techniques showed promising short- term outcomes but required substantial resources. Overall, contemporary minimally invasive cardiac surgery offers comparable safety and improved short-term clinical outcomes compared with conventional approaches, with ongoing technological advancements and structured training playing a critical role in supporting its broader and sustainable implementation.
Keywords
minimally invasive cardiac surgery; mitral valve surgery; aortic valve replacement; clinical outcomes
Cite This Article
Mayun, A. A. K. L. A., Wardani, N. N. H. G. Dipayana, P. G. A. K. (2026). Contemporary advances in Minimally Invasive Cardiac Surgery: Clinical Outcomes, Challenges, and Future Perspectives – A Systematic Review. International Journal of Scientific Advances (IJSCIA), Volume 7| Issue 1: Jan – Feb 2026, Pages 110-116 URL: https://www.ijscia.com/wp-content/uploads/2026/01/Volume7-Issue1-Jan-Feb-No.1023-110-116.pdf
Volume 7 | Issue 1: Jan – Feb 2026
