Beyond Technical Innovation: Organizational and Economic Evaluation of Minimally Invasive Cardiac Surgery – A Narrative Review and Hospital-Level Framework

Background: Minimally invasive cardiac surgery (MICS) is increasingly recognized as an integrated perioperative care model rather than simply a small-incision surgical technique. Its clinical and economic value depends on patient selection, team experience, recovery pathways, institutional resources, and local cost structures.
Objective: This narrative review summarizes the current evidence on the clinical, organizational, and economic value of MICS, and proposes a practical hospital-level framework for evaluating program performance and maturity.
Methods: A structured narrative search of PubMed/MEDLINE, Scopus, Web of Science, and Google Scholar was conducted between January 2010 and June 2026. The review focused on minimally invasive valve surgery, coronary revascularization, enhanced recovery pathways, programme learning curves, resource utilization, and hospital cost analyses. The conduct and reporting of the review were guided by the Scale for the Assessment of Narrative Review Articles (SANRA). Evidence was synthesized across four domains: clinical safety and effectiveness, programme maturity and learning curves, organizational performance, and economic performance. Since the review was interpretive rather than systematic, a formal duplicate-screening workflow, PRISMA flow diagram, or study-level risk-of-bias instrument was not utilized.
Results: MICS can provide outcomes comparable to conventional sternotomy, with shorter intensive care and hospital stays, lower transfusion requirements, fewer wound complications, and earlier mobilization. However, higher operative costs, specialized equipment, longer cardiopulmonary bypass and cross-clamp times, peripheral cannulation risks, conversion to sternotomy, and learning-curve effects may offset postoperative savings. Economic value therefore depends on whether reduced surgical trauma translates into fewer complications and lower overall resource use.
Conclusion: MICS should be evaluated as a value-based care model. Centres developing MICS programmes should monitor risk-adjusted outcomes, resource utilization, conversions, total costs and learning curve dynamics through a structured institutional registry.