Expanding the Boundaries of Minimally Invasive Cardiac Surgery: Initial Experience with Multivalve Procedures

Area of Science:

• Cardiac Surgery
• Minimally Invasive Techniques
• Valvular Heart Disease

Background:

• Minimally invasive valve surgery via right minithoracotomy is established for single valve procedures.
• Application to multivalve operations is uncommon with limited clinical data.
• This study reports initial single-center experience with minimally invasive multivalve surgery.

Purpose of the Study:

• To evaluate the safety and efficacy of minimally invasive multivalve surgery.
• To assess perioperative outcomes and early echocardiographic results.
• To determine feasibility in patients with combined aortic and mitral disease.

Main Methods:

• Retrospective analysis of 10 consecutive patients undergoing minimally invasive multivalve cardiac surgery.
• Operations performed via a 5-7 cm right minithoracotomy with femoral cannulation for cardiopulmonary bypass (CPB).
• Procedures included double-valve (aortic/mitral) and triple-valve (aortic/mitral/tricuspid) operations.

Main Results:

• All 10 procedures completed via minimally invasive approach; no sternotomy conversions or in-hospital deaths.
• Mean CPB and aortic cross-clamp times were 197.6 and 148.1 minutes, respectively.
• No rethoracotomies, wound infections, or peripheral vascular complications; 50% experienced postoperative atrial fibrillation; 90% had good early valve function.

Conclusions:

• Multivalve procedures can be safely extended to a right minithoracotomy approach in experienced centers.
• The technique is associated with low perioperative morbidity and no early mortality.
• Operative times reflect an early learning curve, suggesting potential for optimization.