title: Minimally invasive mitral valve surgery via minithoracotomy and direct cannulation.
abstract: BACKGROUND
  To reduce the morbidity of mitral valve operations, a right anterolateral minithoracotomy under direct vision was introduced. We report our experience with this procedure.
  
  
  METHODS
  From July 2001 to December 2013, 320 consecutive patients underwent direct minimally invasive mitral valve surgery through a right anterolateral minithoracotomy at our institution. Evidence of rheumatic disease was observed in 231 (72%) patients, and 89 (28%) repaired valves had myxomatous changes. Tricuspid valve repair was performed in 80 (25%) patients and radiofrequency ablation in 80 (25%) with chronic atrial fibrillation. All cannulas were introduced through the thoracotomy incision, eliminating femoral cannulation. No new instruments, retractors, or ports were used. Pleural and pericardial drainage was accomplished through a single drain.
  
  
  RESULTS
  There was no hospital death. Conversion to sternotomy was needed in 3 patients because we were unable to obtain satisfactory arterial cannulation. Eight patients required reoperation: 7 for mitral insufficiency and one for postoperative bleeding. Mean cardiopulmonary bypass and crossclamp times were 55.3 ± 17.0 and 43.0 ± 13.4 min, respectively. Mean intensive care unit stay was 29 h, and hospital stay was 4.3 days.
  
  
  CONCLUSIONS
  Based on our experience, this minimally invasive approach is safe, rapid, cost-effective, and more comfortable for the patients, in addition to its cosmetic benefits. It may be the preferred approach in young females.
authors: Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran Pouya_dg@yahoo.com.
authors: Mohammad H
authors: MH
authors: Nezafati
authors: Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors: Pouya
authors: P
authors: Nezafati
authors: Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors: Mahmoud
authors: M
authors: Hosseinzadeh
authors: Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
authors: Sahar Omidvar
authors: SO
authors: Tehrani
mesh_terms: D000328:Adult; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002315:Cardiopulmonary Bypass / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation / Q000706:statistics & numerical data; D013908:Thoracotomy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome
keywords: Heart valve diseases; heart valve prosthesis implantation; minimally invasive; mitral valve; surgical procedures; thoracotomy