Minimally invasive approaches in redo cardiac surgery

Abstract

Redo cardiac surgeries are associated with a high operative risk and mortality, particularly when using conventional median resternotomy. In recent years, increasing attention has been paid to minimally invasive techniques as an alternative to resternotomy in redo procedures. This review analyzes current data from 2015 to 2025 regarding the use of minimally invasive approaches in reoperative cardiac surgery, including mini-thoracotomy, mini-sternotomy, thoracoscopic and robot-assisted techniques, as well as transcatheter interventions. The findings of major meta-analyses and observational studies are summarized, demonstrating a 40–50% reduction in operative mortality, shorter hospital stays, and a lower incidence of complications (infections, acute kidney injury, blood loss) when minimally invasive strategies are employed. Particular attention is given to technical aspects of surgical access, indications, limitations, and future prospects. The review confirms the high efficacy and safety of minimally invasive procedures in redo cardiac surgery and emphasizes the importance of an individualized approach involving a multidisciplinary team.