Leading heart surgeon sums up top coronary artery grafting, heart valve surgery, and robotic surgery options that appeared in the last decade. Let’s start with minimally invasive heart surgery. Dr. Anton Titov, MD. Minimally invasive heart surgery follows a general trend of minimally invasive procedures in surgery. Where in cardiac surgery have minimally invasive methods have been most successful? Dr. Marc Pelletier, MD. It's a great question. Minimally invasive surgery is important in a lot of areas. You think about the biggest challenge with cardiac surgery. It typically has been with harvesting of the vein. About 15 or 20 years ago the technique of endoscopic vein harvesting started to become quite popular. Now it is a standard of care. It's something we've forgotten about. Dr. Marc Pelletier, MD. But I would say it's one of the most important advances in terms of minimally invasive surgery. Because previously a leg incision sometimes would be a foot long, two feet long. Now it is a very small incision. It is one or two centimeters. Patients are able to recover much more quickly. In most areas of the world minimally invasive vein harvesting is now fairly standard. That really set the stage for a lot of other areas that started back about ten years ago or so. This is minimally invasive surgery for the mitral valve. It is minimally invasive surgery for the aortic valve. Now a lot of different techniques have been pioneered for heart valves. Dr. Marc Pelletier, MD. This is the biggest advances we have seen in the last five years. This is the adoption of TAVI or TAVR for the aortic valve. It is replacing the valve just through a small groin incision. It is also the advances in robotic surgery. It is a minimally invasive surgery, especially surgery for the mitral valve. We can now fix or replace mitral valve through a small incision in the chest. Dr. Anton Titov, MD. This is opposed to doing a big incision on the sternum that we had to perform previously.