Is Keyhole Heart Surgery Safe ?

A patient-facing position statement from Keyhole Heart Clinic Last updated: January 2026

Key takeaways (for patients who want the short version first)

• Yes – keyhole (minimally invasive) heart surgery is safe in the modern era for many patients, when it is performed for the right condition, in the right patient, by a well‑trained high‑volume team.
• “Minimally invasive” refers to the access route, not a smaller or less effective operation. The clinical goal is the same: a durable valve repair/replacement or durable bypass grafting—delivered through small incisions instead of a full breastbone split.
• High-quality evidence exists, including randomized trial data for minimally invasive mitral valve repair, showing similar safety outcomes compared with sternotomy in expert hands. [1]
• Transcatheter treatments such as TAVI/TAVR (aortic stenosis) and MitraClip/TEER (selected mitral regurgitation) are also “minimally invasive,” but they are a different category of treatment with different indications, risks, and long‑term considerations. Guidelines support shared decision‑making by a multidisciplinary Heart Team. [3][4]
• Experience matters. At Keyhole Heart Clinic, our team reports over two decades of keyhole cardiac surgery experience and nearly 2,000 keyhole operations; publicly available sources also describe a UK‑first milestone for a quadruple keyhole bypass in 2022, with patient-story content available online. [16]–[20]

Contents

1. What “keyhole heart surgery” actually means
2. Keyhole surgery vs transcatheter procedures (TAVI/TAVR, MitraClip/TEER)
3. What “safe” means in modern heart surgery
4. The evidence—procedure by procedure
   • Mitral valve surgery
   • Aortic valve surgery (minimally invasive SAVR)
   • Aortic root replacement (Mini‑Bentall) and valve‑sparing root surgery (David procedure)
   • Coronary bypass: MIDCAB, TECAB, hybrid strategies, and TCRAT
   • Surgical AF ablation during keyhole surgery
   • Myxoma removal
   • ASD closure: device closure vs keyhole surgical repair
5. Benefits and disadvantages of minimally invasive heart surgery
6. How to find a minimally invasive heart surgeon
7. What to do if your local surgeons do not offer—or do not recommend—keyhole options
8. Questions every patient should ask (with practical explanations)
9. Conclusion
10. References

1) What is “keyhole” (minimally invasive) heart surgery?

Keyhole heart surgery – also called minimally invasive cardiac surgery—means performing a proven heart operation through smaller, carefully planned incisions, commonly including:

• A mini‑thoracotomy (between the ribs, often on the right side for mitral surgery)
• A mini‑sternotomy (a partial opening of the breastbone, often used for aortic valve and some aortic root operations)
• Thoracoscopic/endoscopic or robot‑assisted access in select specialist centres

What it is (and isn’t)

• It is real heart surgery performed to the same clinical standards as conventional surgery.
• It is not “less serious” or purely cosmetic.
• It is not automatically appropriate for every patient. The best access route is the one that lets the team deliver the best operation with the lowest overall risk for your health and anatomy.

2) Keyhole surgery vs transcatheter procedures: why the distinction matters

Patients often hear:

• “You can have minimally invasive treatment like TAVI or MitraClip.”
  These procedures are important advances – but they are not the same as minimally invasive surgical heart surgery.

Minimally invasive surgical heart surgery (keyhole)

• The surgeon directly repairs or replaces the valve (or performs bypass grafts).
• The operation aims for the same durable endpoint as conventional sternotomy surgery.
• It may be performed on cardiopulmonary bypass (heart‑lung machine) for many valve and intracardiac procedures.

Transcatheter therapies (TAVI/TAVR, MitraClip/TEER)

• Performed via catheters (often from the groin).
• Often used in different patient groups or for different anatomical/clinical reasons.
• Long‑term durability and future treatment options can differ depending on age, anatomy, and disease type.

Modern guidelines emphasize that these decisions are best made through a Heart Team approach and shared decision‑making, weighing patient values and long‑term implications. [3][4]

Position statement (patient-facing):
Transcatheter treatments are excellent for the right patient – but they do not eliminate the need for high‑quality surgical repair/replacement. For many people, the real decision is not “catheter vs surgery,” but sternotomy surgery vs keyhole surgery.

3) What does “safe” mean in heart surgery?

Safety is not a slogan. In modern cardiac care, “safe” is assessed through measurable outcomes, including:

• Operative mortality (often reported as in‑hospital or 30‑day)
• Stroke and major neurological events
• Major bleeding / reoperation for bleeding
• Kidney injury, infection, rhythm complications
• Conversion to sternotomy when required for safety
• Durability (repair quality, reintervention rates, graft patency, long‑term function)

For patients, “safe” also includes practical realities:

• Pain control and mobility
• Speed of return to independence
• Ability to exercise, work, drive
• Confidence in long‑term results

4) The evidence in the modern era – procedure by procedure

A) Mitral valve surgery (repair and replacement)

Why mitral repair is so important

For many patients with degenerative (primary) mitral regurgitation, repair (keeping your own valve) is often preferred over replacement when a durable repair is likely—because it preserves heart function and avoids certain prosthetic valve trade‑offs. Contemporary guidelines reflect this emphasis on appropriate timing and durable repair. [3][4]

Is keyhole mitral valve repair safe?

One of the strongest pieces of patient‑relevant evidence is the UK multicenter randomized clinical trial comparing minithoracotomy versus sternotomy mitral repair in degenerative disease. It found:

• No superiority of minithoracotomy for physical function recovery at 12 weeks, but
• Similar safety outcomes at 1 year and high-quality repair in both groups when performed by expert teams. [1]

This matters because it supports a practical conclusion:

In expert hands, minimally invasive mitral repair can be as safe and effective as sternotomy—without relying on marketing or assumptions.

What about large-scale real-world data?

International registry data provide contemporary benchmarks for outcomes in minimally invasive mitral surgery across risk profiles. These data show excellent results in low-, intermediate-, and high-risk patients, with worse outcomes in extreme-risk populations (where any approach is higher risk). [2]

When a keyhole mitral approach may not be best

A reputable program will also tell you when a keyhole approach may not be ideal, for example:

• Severe vascular disease that complicates safe cannulation (in some strategies)
• Complex reoperative anatomy requiring a different exposure strategy
• Emergency settings where the fastest access route may be preferred

B) Aortic valve surgery (minimally invasive SAVR)

If you need an aortic valve replacement, you may hear:

• Surgical AVR (SAVR) via sternotomy or minimally invasive approaches
• TAVI/TAVR via catheter

Guidelines support individualized decision-making based on risk, anatomy, durability considerations, and patient preference, typically through Heart Team review. [3][4]

Is minimally invasive SAVR safe?

Modern systematic reviews and meta-analyses comparing mini‑sternotomy and right anterior mini‑thoracotomy approaches generally show similar perioperative mortality, with differences in certain secondary outcomes (e.g., operative time, bleeding reoperation, stroke) depending on technique and study design. [5]

What patients should take from this:
Minimally invasive SAVR is widely established and can be safe—but technique choice and team experience matter, and outcomes vary by center.

C) Aortic root replacement and valve‑sparing root surgery (David procedure)

Aortic root disease can be frightening to hear about because the aortic root is where:

• The aortic valve sits, and
• The coronary arteries originate

Root surgery is technically demanding, and the safest approach is the one that allows the team to perform the operation with maximum precision and control.

1) Keyhole aortic root replacement (Mini‑Bentall and related approaches)

A “Bentall” operation replaces the aortic root and valve with a composite graft and reimplants the coronary arteries. Minimally invasive root surgery—often via upper mini‑sternotomy (“mini‑Bentall”)—has been evaluated in contemporary studies and technique-focused literature, showing feasibility and encouraging outcomes in appropriately selected patients. [6][7]

A key point for patients:
Root surgery is bleeding‑sensitive. Any program offering keyhole root surgery should be able to discuss their bleeding control strategy and their plan for safe escalation of access if required.

2) The David procedure (valve‑sparing aortic root replacement / VSARR)

The David procedure replaces the diseased aortic root while preserving and reimplanting the patient’s own aortic valve, aiming to avoid prosthetic valve trade‑offs when the native valve is suitable.

A pilot study evaluating minimally invasive valve‑sparing root replacement through upper mini‑sternotomy reported feasibility and safety, underscoring that this is a specialist operation. [8]
Highly technical tutorials also describe performing the David procedure through a right anterior mini‑thoracotomy in selected cases, again highlighting that this approach is reserved for experienced teams and carefully chosen anatomy. [9]

Position statement:
Keyhole aortic root replacement and David procedures can be safe and effective in the modern era—but they should be viewed as advanced specialist surgery where team volume, systems, and meticulous technique are primary safety variables, not optional extras. [6]–[9]

D) Coronary bypass (CABG): MIDCAB, TECAB, hybrid strategies, and TCRAT

Coronary artery disease is where patients most often assume sternotomy is unavoidable. Today, there are multiple sternum‑sparing strategies—though they are not available everywhere.

1) MIDCAB (Minimally Invasive Direct Coronary Artery Bypass)

MIDCAB usually targets the left anterior descending (LAD) artery with a LIMA‑to‑LAD graft via a small left chest incision, often on the beating heart.

Long‑term data support MIDCAB as a durable and safe strategy, with very good early and long-term outcomes in experienced centers. [11]

2) TECAB (Totally Endoscopic Coronary Artery Bypass) and robotic CABG

TECAB involves performing bypass grafting using endoscopic/robotic platforms through small ports. It is technically demanding and typically limited to specialist programs.

A systematic review/meta-analysis of two decades of robotic CABG outcomes describes acceptable perioperative outcomes and promising graft patency in reported series, while recognizing that program experience and case selection are central to success. [12]

3) Hybrid Coronary Revascularization (HCR)

Hybrid strategies combine:

• A minimally invasive surgical LIMA‑to‑LAD graft (often MIDCAB or robotic) plus
• PCI (stents) to other vessels

Modern reviews outline indications, sequencing strategies, and practical considerations, emphasizing that HCR aims to combine the durability of LIMA‑to‑LAD with the less invasive nature of PCI for non‑LAD disease. [13]
The concept aligns with contemporary guideline frameworks for coronary revascularization selection. [10]

4) Multivessel “sternum‑sparing” CABG and TCRAT

Total Coronary Revascularization via Anterior Thoracotomy (TCRAT) is a sternum‑sparing approach for multivessel bypass performed through a left anterior thoracotomy with specialized strategies (often including peripheral cannulation and cardioplegic arrest). Published series describe promising early and midterm outcomes, supporting its feasibility as a sternum-sparing alternative in appropriate patients. [14][15]

Important reality check:
Multivessel sternum‑sparing CABG is not widely available because it is complex and system‑dependent—this is one reason patients may be told locally that sternotomy is “the only option.”

E) AF (atrial fibrillation) ablation during minimally invasive heart surgery

AF is common in patients needing valve surgery and is clinically important because it affects symptoms, quality of life, hospital admissions, and stroke risk.

Is surgical AF ablation recommended in modern practice?

Yes. The Society of Thoracic Surgeons (STS) 2023 Clinical Practice Guidelines (published 2024) emphasize the long-term benefits of surgical ablation and extend recommendations to perform surgical ablation in AF patients undergoing first-time, nonemergent cardiac surgery, with a Class I recommendation for left atrial appendage occlusion (LAAO) in this setting. [21]

The value of LAAO is supported by randomized trial evidence (LAAOS III), showing reduced risk of ischemic stroke/systemic embolism in AF patients undergoing cardiac surgery, on a background of anticoagulation. [22]

Can AF ablation be done through keyhole approaches?

In experienced minimally invasive programs—particularly those performing keyhole mitral surgery—surgical AF ablation can often be performed concurrently, using established lesion sets and LAA management strategies. The right plan depends on your AF type (paroxysmal vs persistent), left atrial size, and the primary operation.

Patient-focused message:
If you have AF and you are having cardiac surgery anyway, it is reasonable to ask whether concomitant AF ablation and LAA management are recommended for you—and what outcomes the program achieves. [21][22]

F) Myxoma removal (cardiac tumour surgery) via keyhole approaches

A cardiac myxoma is usually benign, but it is often removed promptly because of risks such as embolism (stroke) and obstruction of blood flow.

Minimally invasive removal via mini‑thoracotomy has been reported with acceptable clinical and neurological outcomes and reliable resection in medium-term follow-up. [23]
More recent comparative work continues to evaluate minimally invasive approaches against sternotomy for postoperative outcomes. [24]

What patients should listen for:

• How the team minimizes embolic risk during tumor handling
• Use of intraoperative imaging (TEE) to confirm complete resection
• Follow-up strategy for recurrence surveillance

G) ASD closure: device closure vs keyhole surgical repair

An atrial septal defect (ASD) is a hole between the upper chambers of the heart. Some ASDs are suited to device closure via catheter; others require surgery.

When catheter (device) closure is preferred

A major US guideline released in December 2025 states that in adults with an isolated unrepaired secundum ASD, transcatheter closure is usually preferred over surgical repair to reduce length of stay and recovery time, when feasible. [25]

When surgical closure is still the right option

Surgery may be recommended when:

• Anatomy is unsuitable for a device
• The ASD type is not suitable for device closure (e.g., sinus venosus defects)
• There are associated cardiac issues requiring surgery

Is keyhole surgical ASD closure safe?

Modern studies report minimally invasive thoracotomy approaches as safe and associated with favorable short-term recovery metrics compared with conventional approaches in selected patients. [26]
Robot-assisted ASD repair (including beating-heart strategies) has also been reported as feasible and safe in experienced settings. [27]
A recent systematic review summarizes outcomes across minimally invasive surgical ASD approaches and describes very low perioperative mortality in reported series, with reduced length of stay and good clinical outcomes. [28]

Patient-friendly interpretation:
If your ASD can be closed safely by catheter, that may be the least invasive path. If you need surgery, a keyhole surgical approach may allow a definitive repair without a full sternotomy in suitable patients. [25]–[28]

5) Benefits of keyhole (minimally invasive) heart surgery

When performed appropriately, potential benefits include:

• Avoiding full sternotomy (in many keyhole programs) and reducing sternum-related healing restrictions
• Smaller incisions and scars
• Potentially less pain and earlier mobility (varies by operation and individual)
• Potentially shorter hospital stay in selected cohorts
• Reduced risk of deep sternal wound complications in procedures that avoid splitting the sternum

Important qualifier:
Benefits are most predictable when performed in a mature, specialist program with standardised pathways and robust safety protocols.

6) Disadvantages, trade-offs, and honest limitations

A credible position statement must be balanced. Potential disadvantages include:

• Not universally available. Many hospitals do not have a dedicated minimally invasive cardiac program.
• Learning curve effects. Outcomes depend on surgeon and team experience; “minimally invasive” is not interchangeable across centres.
• Different technical demands. Some approaches may increase operative times, require specialised perfusion strategies, or have distinct risk profiles.
• Not every patient is suitable. A minimally invasive approach should not be forced if it compromises exposure or the ability to deliver the best operation.
• Conversion to sternotomy can be necessary. This is not “failure” – it is often a safety decision.

7) How to find a minimally invasive heart surgeon (and choose wisely)

Instead of looking only for the words “minimally invasive” on a website, look for evidence of volume, transparency, and systems.

What to ask (and why it matters)

A. Experience and volume

• “How many of this exact procedure do you perform minimally invasively each year?”
  Aortic root surgery, mitral repair, and multivessel bypass are not interchangeable.

B. Outcomes that matter

• “What are your rates of stroke, reoperation for bleeding, infection, and conversion?”
• “What is your typical length of stay for patients like me?”
• “What is your durability follow‑up plan?”

C. Procedure-specific questions

• Mitral: “What is your repair rate for degenerative mitral regurgitation?” [1]
• Aortic root/David: “How often do you perform valve‑sparing root surgery, and what makes my valve suitable?” [8][9]
• Coronary: “Am I suitable for MIDCAB, TECAB, hybrid, or sternum‑sparing multivessel CABG (such as TCRAT)?” [11]–[15]
• AF: “Will you perform concomitant AF ablation and LAA occlusion, and what outcomes do you see?” [21][22]

8) What if local surgeons don’t do – or don’t recommend – keyhole surgery?

This is common, and it does not automatically mean anyone is wrong.

If they don’t offer it

It may simply reflect:

• Program availability
• Team volume
• Equipment and ICU pathway limitations

What you can do:

• Request referral to a specialist minimally invasive center.
• Seek a second opinion from a surgeon who routinely performs the approach.
• Ask for your imaging to be shared (echo reports, angiograms, CT scans).

If they don’t recommend it

That could be for valid reasons (anatomy, risk profile, urgency). Ask:

• “What specifically makes me unsuitable for a minimally invasive surgical approach?”
• “Is this due to my anatomy/medical risk, or local program limitations?”

The value of second opinions

A second opinion is often less about “who is right” and more about:

• Confirming that surgery is needed now (timing matters)
• Clarifying the best procedure (repair vs replacement, surgical vs transcatheter)
• Clarifying the best access route (sternotomy vs keyhole)

Guidelines repeatedly support multidisciplinary decision-making for complex choices. [3][4][10]

9) Keyhole Heart Clinic: our position and program experience

Our core position:
Minimally invasive heart surgery should be offered as a serious, evidence‑based option – not as a trend, and not as a compromise on surgical quality.

Program experience

Keyhole Heart Clinic publicly states that the team has been performing keyhole heart surgery for more than 20 years, and a clinic blog describes nearly 2,000 keyhole surgeries over ~20 years. [19][20]
(Internally, we describe our program as now entering its 23rd year, with nearly 2,000 patients treated—reflecting continuity of practice and documented outcomes.)

Multivessel keyhole bypass: specialist capability

A Cromwell Hospital article describes multivessel minimally invasive coronary surgery (TCRAT) as offered in only a small number of hospitals worldwide and states that Mr Inderpaul Birdi performed the UK’s first quadruple heart bypass via keyhole surgery in 2022. [16]
Public profiles similarly describe the UK-first quadruple keyhole bypass milestone and characterise this capability as held by only a small number of surgeons globally. [17][18]

Patient-story evidence and transparency

The clinic maintains publicly accessible video content, including patient perspective material relating to quadruple keyhole coronary bypass. [20]

Patient-facing commitment:
Patients should never feel pressured into a technique. Our role is to explain—clearly and transparently—whether a minimally invasive approach can deliver the best operation for your heart safely, and what alternatives exist if it cannot.

Frequently asked questions (FAQ)

“Is keyhole heart surgery just cosmetic?”

No. The goal is not appearance – it is to reduce surgical trauma where possible while preserving the quality and durability of the operation.

“Is keyhole heart surgery safer than sternotomy?”

In many settings, major safety outcomes can be similar in expert hands, and some recovery-related outcomes may be improved in selected patients. For mitral valve repair, randomised trial evidence supports similar safety outcomes at one year when performed by expert teams. [1]

“Do all minimally invasive approaches avoid the heart-lung machine?”

No. Many valve, intracardiac, and root procedures still require cardiopulmonary bypass. Some coronary procedures (like MIDCAB) are often performed off-pump. [11]

“If something unexpected happens, can the surgeon switch to sternotomy?”

Yes – responsible programs plan for escalation. Conversion is a safety decision when needed.

“Why isn’t keyhole surgery offered everywhere?”

Because it requires:

• Specialised training
• A dedicated multidisciplinary team
• Consistent case volume
• Mature ICU and recovery pathways
  This is particularly true for advanced procedures like aortic root surgery and multivessel sternum-sparing CABG. [6]–[9][14][15]

Conclusion

Keyhole (minimally invasive) heart surgery is safe in the modern era for many patients—when it is performed in the right patient, for the right operation, by an experienced specialist team. Evidence supports its role across mitral valve surgery, minimally invasive aortic valve surgery, selected aortic root operations (including David procedures), coronary bypass strategies (MIDCAB/TECAB/hybrid and specialist sternum‑sparing multivessel approaches such as TCRAT), and selected intracardiac procedures such as AF ablation, myxoma removal, and ASD repair. [1]–[15][21]–[28]

If you have been told keyhole surgery is not possible, you deserve a clear explanation—and, in many cases, a second opinion from a center that routinely performs minimally invasive approaches.

Medical disclaimer

This article is for education only and is not individual medical advice. Treatment decisions should be made with your treating clinicians after review of your imaging, symptoms, and overall health. If you have urgent symptoms (severe chest pain, sudden breathlessness, fainting, or signs of stroke), seek emergency care immediately.

References

1. Akowuah EF, et al. Minithoracotomy vs Conventional Sternotomy for Mitral Valve Repair: A Randomized Clinical Trial. JAMA. 2023.
2. Berretta P, et al. Risk-related clinical outcomes after minimally invasive mitral valve surgery: insights from the Mini-Mitral International Registry (MMIR). European Journal of Cardio‑Thoracic Surgery. 2023.
3. European Society of Cardiology (ESC). 2025 ESC/EACTS Guidelines for the management of valvular heart disease (VHD). ESC guideline hub. 2025.
4. Otto CM, et al. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. Circulation. 2021.
5. Starvridis D, et al. Mini‑Sternotomy vs Right Anterior Mini‑Thoracotomy for Surgical Aortic Valve Replacement: A Systematic Review and Meta‑Analysis. 2025 (available via PubMed Central).
6. Avdagic H, et al. Minimally Invasive Aortic Root Surgery (Mini‑Bentall). 2025 (PubMed/PMC).
7. Shah VN, et al. The mini‑Bentall approach: comparison with full sternotomy. JTCVS Techniques. 2021.
8. Shrestha M, et al. Minimally invasive valve-sparing aortic root replacement via upper mini‑sternotomy (feasibility/safety pilot study). 2015 (PubMed Central).
9. Multimedia Manual of Cardio‑Thoracic Surgery (MMCTS). The David procedure through a right anterior mini‑thoracotomy. 2023.
10. Lawton JS, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization. Circulation. 2022.
11. Davierwala PM, et al. Twenty‑year outcomes of minimally invasive direct coronary artery bypass (MIDCAB). Journal of Thoracic and Cardiovascular Surgery. 2023.
12. Hwang B, et al. Systematic review and meta‑analysis of two decades of reported outcomes for robotic coronary artery bypass grafting (RA‑MIDCAB/TECAB). Annals of Cardiothoracic Surgery. 2024.
13. Fazmin IT, et al. Hybrid Coronary Revascularisation: Indications, Techniques and Outcomes. 2025 (PubMed Central).
14. Sellin C, et al. Sternum‑sparing multivessel coronary surgery as a routine strategy: total coronary revascularization via left anterior thoracotomy (TCRAT). JTCVS Techniques. 2024.
15. Demirkıran T, et al. Total coronary revascularization via left anterior thoracotomy (TCRAT) compared with conventional CABG (sternotomy). 2024 (PubMed).
16. Cromwell Hospital. Keyhole heart surgery: benefits for patients (includes UK-first quadruple keyhole bypass claim and TCRAT statement). 2025.
17. The Keyhole Heart Clinic. Mr Inderpaul Birdi profile (includes UK-first quadruple keyhole bypass claim and “handful worldwide” statements).
18. Top Doctors (UK). Mr Inderpaul Birdi profile (includes UK-first quadruple keyhole bypass claim and “handful worldwide” statements).
19. The Keyhole Heart Clinic blog. Why Nigerian patients choose London for keyhole heart surgery (mentions nearly 2,000 keyhole surgeries over ~20 years).
20. The Keyhole Heart Clinic (YouTube). “Quadruple Keyhole Coronary Bypass: A Patient’s Perspective.”
21. von Ballmoos MCW, et al. The Society of Thoracic Surgeons 2023 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Annals of Thoracic Surgery. Published 2024 (STS 2023 guideline update).
22. Whitlock RP, et al. Left Atrial Appendage Occlusion during Cardiac Surgery to Prevent Stroke (LAAOS III). New England Journal of Medicine. 2021.
23. Shin C, et al. Surgical Outcomes of Cardiac Myxoma Resection Through Mini‑Thoracotomy. 2022/2023 (PubMed Central).
24. Ríos‑Ortega JC, et al. Minithoracotomy for the excision of cardiac myxoma (comparative postoperative outcomes). 2025.
25. ACC/AHA/HRS/ISACHD/SCAI. 2025 Guideline for the Management of Adults With Congenital Heart Disease (includes statement on transcatheter closure usually preferred for isolated secundum ASD when feasible). Circulation. 2025.
26. Ullah A, et al. Comparison of short‑term outcomes: minimally invasive thoracotomy vs conventional approaches for ASD closure. 2025 (PubMed Central).
27. Yun T, et al. Robot‑assisted repair of atrial septal defect (including beating‑heart approach) feasibility and safety. 2022 (PubMed Central).

• 28. Ryaan ELA, et al. A Systematic Review of Minimally Invasive Approaches to Surgical Atrial Septal Defect Repair. 2025.

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