Surgical treatment of double and triple heart valve disease through a limited single-access right minithoracotomy

Heart valve disease can be extensive and may include double (mitral-aortic, mitral-tricuspid), or triple (mitral, aortic, and tricuspid) valvular regurgitation. The surgical correction of significant valvular regurgitation usually consists of the repair or replacement of all valves affected by a pathologic process. The median full-length sternotomy still serves as a classic approach for single, double, and triple valve operations in most patients. Here, we present a minimally invasive approach for the surgery of double and triple heart valve disease through a limited single-access right minithoracotomy in the 3rd intercostal space, with central aortic and percutaneous venous cannulation. A total of 48 double valve procedures were performed in our department using this technique. The minimally invasive approach through a right single-access thoracotomy has become our choice for all isolated mitral valve, and for most isolated aortic valve, replacement procedures. Triple valve surgery was performed in six cases and was feasible in all selected patients.