Combined Mitral and aortic valve surgery through a right minithoracotomy

Background: Minimally invasive approaches are more and more used for isolated aortic or mitral valve procedures. However, minimally invasive combined mitral and aortic valve surgery is still uncommon. We report our experience performing multiple valve procedures through a right-sided mini-thoracotomy.

Methods: From November 2013 to November 2023, 38 patients underwent aortic and mitral valve surgery through right anterior thoracotomy.

Results: Median (Q1-Q3) age of our population was 72 years (60,5-76) and 61% were females. Median (Q1-Q3) logistic Euroscore was 4.25 (2.8-6.9) and median (Q1-Q3) EuroSCORE II was 2.27 (1.9-5). Three patients (7.8%) were redo operations. Median cardiopulmonary bypass and ross-clamp times were 98 (83-150) minutes and 85 (71-115) minutes, respectively. No conversion to full sternotomy was necessary. In-hospital mortality was 2.6% (1 patient) who died for septic shock and consequent multi-organ failure. 53% of patients required transfusions with packed blood cells. Post-operative atrial fibrillation was observed in 12 patients (32%) and 2 patients (5.2%) required Pace-maker implantation due to third degree AV block. Also, 1 (2.6%) stroke and 1 re-thoracotomy for bleeding were observed. Median (Q1-Q3) ventilation time was 10 hours (6-15). Median (Q1-Q3) intensive care unit postoperative length of stay were 2 (2-2) days and 7.5 (7-9) days respectively. Survival al 1, 3, 5 and 10 years was 93.8%, 86.3%, 86.3%, 77.2% respectively with a median follow-up time of 6.5 years. Freedom from re-intervention al 1, 3, 5 and 10 years was 96.8%, 89.5%, 85.0%, 69.5% respectively with a median follow up time of 5.7 years.

Conclusions: In our experience, a minimally invasive approach for combined aortic and mitral valve surgery is safe and feasible, with acceptable cardiopulmonary bypass and cross-clamp times and good outcomes. Therefore, it can be an attractive option for patients with double valve diseases. Further studies are needed with a bigger population and a comparison to full sternotomy results.