Past, present, and future of minimal access cardiac surgery

Minimal access cardiac surgery (MACS) has seen a tremendous evolution since the start of the 21st century. Over the past decade, significant advances in techniques and technology have made MACS a valid option for performing a variety of cardiac surgical procedures that were only deemed possible through traditional full median sternotomy. A desire to minimize the morbidity associated with full sternotomy, such as decreased pain and reduced surgical trauma, and a perception that reduced morbidity translates into speedy recovery are the main drivers for increasing growth of MACS (1). At the same time skepticism regarding the safety of MACS, particularly concerns over reduced surgical exposure in highly complex operations, the potential for prolonged operative times, difficulty to deal with technical complications through limited exposure, and last but not the least a steep learning curve, has precluded universal adoption of MACS.