Related Experiment Video
Updated: May 5, 2026
Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
Published on: March 26, 2018
Lower Ministernotomy: An Approach for Treating All Valvulopathies?
Pichoy Danial1, Anouk Frering2, Hanae Bouhdadi2
1Department of Cardiovascular and Thoracic Surgery, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Public Assistance Hospitals of Paris (AP-HP), Paris, France; French Clinical Research Infrastructure Network (F-CRIN) Cardiovascular and Renal Clinical Trialists (INI-CRCT), Nancy, France.
Insights
Lower ministernotomy is a safe and effective surgical approach for various heart valve conditions and intracardiac procedures, demonstrating excellent patient outcomes and low complication rates.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Valvular Heart Disease
Background:
- Lower ministernotomy provides superior visualization of all four cardiac chambers.
- This approach facilitates surgical treatment for aortic, mitral, and tricuspid valve diseases, as well as intracardiac procedures.
- Limited data exists on the technical aspects, safety, and echocardiographic outcomes of lower ministernotomy.
Purpose of the Study:
- To evaluate the outcomes of lower ministernotomy in patients undergoing valvulopathy treatment.
- To assess the safety and efficacy of lower ministernotomy for other intracardiac surgical procedures.
Main Methods:
- Retrospective study including adult patients (over 18 years) undergoing cardiac surgery via lower ministernotomy.
- Data collected from January 2017 to March 2023 at Pitié-Salpêtrière Hospital, Paris.
- Key outcome variables included all-cause mortality, postoperative complications, and echocardiographic results.
Main Results:
- 633 patients underwent lower ministernotomy for aortic valve surgery (338), mitral valve surgery (254), combined valve surgery (25), or other intracardiac procedures (38).
- Hospital survival rates ranged from 96% to 99.1% across different surgical groups.
- Low rates of complications were observed: 2.1% mediastinitis, 1.7% permanent stroke, and 7.5% new pacemaker implantation.
Conclusions:
- Lower ministernotomy is a safe and effective surgical approach for treating valvulopathies and other intracardiac diseases.
- The procedure is associated with low rates of morbidity and mortality.
- This technique is suitable for isolated or combined valve surgeries and other intracardiac interventions.
Background:
Lower ministernotomy offers the advantage of providing excellent visualization of the 4 cardiac cavities, thus allowing surgical treatment of the aortic, mitral, and tricuspid valves as well as any intracavitary procedure. Information on technical issues, as well as safety and echocardiographic results of this approach, are sparse. The aim of this retrospective study was to describe outcomes of lower ministernotomy to treat valvulopathies and for other intracardiac surgical procedures.
Methods:
All consecutive patients aged more than 18 years who underwent cardiac surgery by ministernotomy between January 2017 and March 2023 in our institution (Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France) were included in this retrospective study. Main outcome variables were all-cause mortality, postoperative complications, and echocardiographic results.
Results:
During the 6-year study period, 633 patients were treated through a lower ministernotomy. Among them, 338 patients had aortic valve surgery (AVS) with or without tricuspid annuloplasty (TA), 254 had mitral valve surgery (MVS) with or without TA, 25 had AVS and MVS with or without TA, and 38 had other types of intracardiac surgery. Hospital survival was 99.1% in the AVS group, 98.1% in the MVS with or without TA group, 96% in the AVS and MVS with or without TA group, and 97.4% in the other intracardiac surgery group. Only 1 patient required repeat osteosynthesis in the entire cohort, and 12 (2.1%) patients had mediastinitis. A total of 162 (25%) patients received transfusions, 11 patients (1.7%) had permanent strokes, and 49 (7.5%) underwent new pacemaker implantation.
Conclusions:
Lower ministernotomy is a safe approach for treating all valvulopathies, separately or concomitantly, and other intracardiac diseases, and it is associated with a low rate of morbidity and mortality.
Related Concept Videos
01:27Mitral Valve Prolapse I: Introduction
01:22Mitral Valve Prolapse II: Assessment and Management
01:19Mitral Valve Prolapse III: Nursing Management
01:25Mitral Regurgitation III: Medical Management
01:26Mitral Stenosis III: Medical Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management