Left-side approach to the mitral valve

The standard, minimally invasive surgical approach to the mitral valve is usually accomplished from the right side, through a longitudinal incision posterior and parallel to the interatrial groove. The left-side approach should perhaps be reconsidered for its suitable exposure of the mitral valve.

Eleven consecutive patients underwent mitral valve surgery via a left lateral minithoracotomy, with cardiopulmonary bypass performed through the left femoral artery and vein. The left internal mammary artery was used as a coronary graft in one patient. Cardioplegic solution was delivered through the ascending aorta. After direct aorta cross-clamping, mitral surgeries were performed, including mechanical and bioprosthetic implants, redo operations, annuloplasties and repairs.

An excellent view of the mitral valve was obtained in all cases, with optimal vision of the whole annulus, chordae tendineae, papillary muscles and aortic valve possible. Exposure of the mitral valve was superior to that achieved with the standard approach from the right, notably with a wider angle of vision and greater flexibility of movement available. Moreover, mitral valve structures were closer to the operator, making the procedure easier to perform.

The left-side approach to the mitral valve offers excellent vision and exposure of the valve. Although awaiting additional cases to validate results, in the absence of major complications we recommend this technique.