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EP23 MINIMALLY INVASIVE MITRAL SURGERY THROUGH A RIGHT VERTICAL AXILLARY MINITHORACOTOMY: PRELIMINARY EXPERIENCE

Background and Aim: right antero-lateral minithoracotomy through the 3rd or 4th intercostal space is the classic approach for minimally invasive mitral surgery. We report our experience with an alternative and more cosmetic minimally invasive port-access through a right vertical axillary minithoracotomy (RVAMT). Methods: between July 2016 and April 2018, 60 patients (32 females and 28 males, mean age 66.2 ± 11.1 years) underwent mitral valve surgery through a RVAMT. Forty-six mitral valve repairs were performed, 4 associated to tricuspid repair. Only 14 pathological mitral valves have been replaced. RVAMT was performed by a 5–6 cm incision through the 4th intercostal space placed vertically along the antero-axillary line rather than antero-laterally along the intercostal space. All surgical procedures were performed without an endoscopic system. Results: mean CPB time and aortic cross clamp were 130.2 ± 26.1 minutes and 90.6 ± 16.6 minutes, respectively. There was no approach-related limitation to surgical exposure. Bleeding requiring surgical revision occurred in two patients. Median intensive care unit stay and mean mechanical ventilation time were 24 and 8.3 ± 5.4 hours, respectively. In-hospital mortality was 1.7% (1/60 patients). Overall survival at 6 months follow-up was 100%. Conclusions: RVAMT is a safe alternative, reproducible, cosmetic and minimally invasive approach for mitral valve surgery. It provides an optimal surgical viewing perpendicular to the mitral plane with satisfactory valve exposure and the possibility to perform surgery under direct vision. The cosmetic advantage of the RVAMT is the short incision under the armpit that is often invisible.