Minimally Invasive Versus Full Sternotomy Approaches in Mitral Valve Surgery for Infective Endocarditis: A Retrospective Comparative Analysis.

Background: This study evaluates the outcomes of isolated mitral valve surgery for infective endocarditis performed via conventional full sternotomy or minimally invasive right minithoracotomy. While minimally invasive surgery (MIS) is well-established for elective mitral procedures, its role in infective endocarditis remains less explored due to the complexity of the disease. Methods: A retrospective analysis of 134 patients who underwent isolated mitral valve surgery for infective endocarditis between January 2010 and March 2024 was conducted. Patients were divided into two groups based on the surgical approach: full sternotomy (n = 94) and MIS via right minithoracotomy (n = 40). Variables analyzed included preoperative characteristics, intraoperative details, and postoperative outcomes, such as mortality, complications, and hospital stay duration. Given significant baseline differences, inverse probability weighting was applied for comparability. Results: Mitral valve replacement was performed in 77% of cases. After adjustment, the MIS group demonstrated shorter intensive care unit stays (p = 0.018), with no significant differences in in-hospital mortality (p = 0.145) or total hospitalization length (p = 0.151). Conclusions: Minimally invasive mitral valve surgery is a safe and effective alternative to sternotomy in infective endocarditis, offering comparable outcomes with shorter ICU stays. Further research is needed to refine patient selection and validate these findings.