title: Outcomes of minimally invasive triple valve surgery performed via a right anterior thoracotomy approach.
abstract: OBJECTIVE
  The feasibility of minimally invasive triple valve surgery performed via a right anterior thoracotomy approach was evaluated.
  
  
  METHODS
  A retrospective analysis was conducted on all patients who underwent minimally invasive triple valve surgery via a right anterior thoracotomy approach at the authors' institution between December 2009 and February 2013. The operative times and intensive care unit and hospital lengths of stay, postoperative complications, and mortality were analyzed.
  
  
  RESULTS
  Six patients (three males, three females; mean age 76.7 +/- 5.4 years) were identified. Five patients had a prosthetic aortic valve, and one patient had an aortic valve repaired by commissuroplasty. In four patients the mitral valve repair was effected with an annuloplasty ring, while in two patients a transaortic edge-to-edge mitral valve repair was performed. All patients had tricuspid valve repair with a ring annuloplasty. The median aortic cross-clamp time was 136 min (IQR: 119-188 min), and the median cardiopulmonary bypass time was 185 min (IQR: 145-231 min). The median intensive care unit and hospital lengths of stay were 62 h (IQR: 50-111 h) and 12 days (IQR: 7-23 days), respectively. There were no postoperative cerebrovascular accidents, myocardial infarctions or acute kidney injuries. Two patients developed post-surgical atrial fibrillation, and two died at 30 days postoperatively.
  
  
  CONCLUSIONS
  In patients requiring triple valve surgery, a minimally invasive approach performed via a right anterior thoracotomy may be a feasible option in these high-risk patients.
authors.affiliation: Department of Internal Medicine, Mount Sinai Medical Center, Miami Beach, Florida 33140, USA.
authors.forename: Hany M
authors.initials: HM
authors.lastname: Elmahdy
authors.affiliation: Columbia University, Division of Cardiology, Miami Beach, Florida, USA.
authors.forename: Francisco O
authors.initials: FO
authors.lastname: Nascimento
authors.affiliation: Columbia University, Division of Cardiology, Miami Beach, Florida, USA.
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.affiliation: Department of Cardiac Surgery, Mount Sinai Heart Institute, Miami Beach, Florida 33140, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Lamelas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008297:Male; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013908:Thoracotomy / Q000379:methods*; D014261:Tricuspid Valve / Q000601:surgery*; D014481:United States / Q000453:epidemiology