Simplified Approach for Minimally Invasive Mitral Valve Surgery Through a Transaxillary Minithoracotomy Access

BACKGROUND: Concerns still exist regarding increased technical complexity and longer operative times associated with minimally invasive cardiac procedures. To help overcoming this view and the skepticism about the value of performing cardiac surgery through reduced incisions, we present and discuss our experience with a simplified minimally invasive surgical setup using right transaxillary minithoracotomy direct view access. METHODS: This is a retrospective study that was based on an institutional database and included consecutive patients who underwent transaxillary mitral valve surgery from January 2017 to December 2024. RESULTS: The study included 615 patients. Mitral valve repair for degenerative disease was performed in 94% of patients, and tricuspid valve surgery was associated in 16%. Mean cardiopulmonary bypass and cross-clamp times were 105 ± 32 and 65 ± 23 minutes, respectively. Thirty-day mortality and stroke or transient ischemic attack rates were 0.3% and 0.9%, respectively. Median postoperative intubation time was 2 hours (interquartile range IQR, 0-6 hours), with 51% of patients extubated in the operating room. Median intensive care unit and hospital stays were 24 hours (IQR, 22-48 hours) and 7 days (IQR, 6-8 days), respectively. Residual mitral regurgitation was none or mild in 98% of patients who underwent repair procedures; recurrent moderate or greater regurgitation occurred in 1.4% of patients at 1 year and in 11% at 5 years. Survival probabilities at 1 and 6 years were 99% and 96%, respectively. CONCLUSIONS: Minimally invasive mitral surgery through the transaxillary approach ensures outstanding technical results with a low risk of perioperative complications. Increasing the perceived value of minimally invasive procedures through a simplified surgical setup can facilitate the initiation and wider adoption of a minimally invasive cardiac surgery program.