Article Abstract

Minimally invasive approach for double and triple valve surgery

Authors: Antonio Lio, Antonio Miceli, Matteo Ferrarini, Mattia Glauber


Background: Although benefitsof minimally invasive cardiac surgery have been described when compared with astandard approach through a median sternotomy, few experience and data exist inthe setting of double and triple valve surgery, whose annual incidence is 3% to25% of all valve surgery. We describe our experience with minimally invasivemultiple valve surgery through a right minithoracotomy.
Methods: All patients scheduled for aminithoracotomy approach underwent a preoperative evaluation, includingcomputed tomography scan and epiaortic and femoral vessels ultrasound. Mitraland tricuspid valve disease is treated through a right minithoracotomy performedthrough a 4–5 cm lateral skin incision at the level of the fourth intercostalspace. In case of mitro-aortic or triple valve disease, the procedure iscarried out through a 5–7 cm incision in the 3rd intercostal space at 2–4 cmfrom the sternal edge. A femoral platform is generally used for cardiopulmonarybypass estabilishment, but, in selected patients, a central aortic cannulationcould be also performed to allow an antegrade perfusion.
Results: We have started our minimally invasiveprogram in 2003. Gaining experience with the minithoracotomy, all patients witha concomitant mitral and tricuspid valve disease were treated with this kind ofapproach. In 1,604 patients undergoing minimally invasive mitral valve surgeryover a 10-year period, concomitant tricuspid valve repair was performed in 234patients (14.6 %), with good early and long-term outocomes. The next step,especially after the introduction of sutureless aortic prostheses, wasrepresented by the minimally invasive treatment of mitro-aortic and triplevalve disease. Sixty-nine patients underwent concomitant mitral and aorticvalve surgery through a right minithoracotomy, and a triple valve surgery wasperformed 12 (17.4%) of them. Good results were obtained in terms ofpostoperative mortality and morbidity.
Conclusions: Double and triplevalve surgery through a right minithoracotomy is a feasible approach in thissubgroup of high-risk patients.