Priority 6 from the Heart Surgery PSP

UNCERTAINTY:How does minimally-invasive heart surgery compare to traditional open surgery?  (JLA PSP Priority 6)
Overall ranking 6
JLA question ID 0088/6
Explanatory note Minimally invasive techniques have been developed that allow surgery to be performed through smaller incisions, or without the use of the heart lung machine. These operations reduce the extent of the surgical incision and have been shown to limit perioperative bleeding and blood transfusion in trials. However, minimally invasive techniques are technically more challenging and therefore have potential additional risks. Whether these operations are better than traditional open surgery or new percutaneous techniques and devices is unclear. ~ People asked is Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) better then open heart surgery? Does endoscopic vein harvesting EVH contribute to early discharge and better patient experience? 
Evidence

Kirmani BH, Jones SG, Malaisrie SC, Chung DA, Williams R. Limited versus full sternotomy for aortic valve replacement. Cochrane Database of Systematic Reviews. 2017(4); Abraha I, Romagnoli C, Montedori A, Cirocchi R. Thoracic stent graft versus surgery for thoracic aneurysm. Cochrane Database of Systematic Reviews. 2016(6);  
Health Research Classification System category Cardiovascular
Extra information provided by this PSP
Original uncertainty examples Will minimally invsive techniques make real difference to patients? ~ Is endoscopic vein harvesting better than open? ~ Is Minimally Invasive Direct Coronary Artery Bypass (MIDCAB) better then open heart surgery? ~ Can heart valve replacement surgery be carried out with minimally invasive surgery as opposed to standard ‘open chest’ method? ~ What are the risks/benefits of robotic procedures; given the longer operating times? 
Submitted by 8 x patient, 7 x carer, 38 x healthcare professionals, 4 x others 
PSP information
PSP unique ID 0088
PSP name Heart Surgery
Total number of uncertainties identified by this PSP. 45  (To see a full list of all uncertainties identified, please see the detailed spreadsheet held on the JLA website)
Date of priority setting workshop 11 July 2019