International Society For Minimally Invasive Cardiothoracic Surgery

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Minimally Invasive Mitral Valve Repair Through The Third Intercostal Space
marco diena.
Cardioteam Foundation. San Gaudenzio Clinic, Novara, Italy.

OBJECTIVE: Minimally invasive mitral valve surgery is usually performed via the fourth intercostal space and periferal arterial cannulation.From this approach the visualization of the posterior aspect of the mitral valve and commissure is difficult and diaphragm may impair the direct vision. We present an alternative technique through the third intercostal space and direct aortic cannulation and cross clamping.
METHODS: Skin incision is performed below the right nipple and the minithoracotomy in the third intercostal space. Direct aortic cannulation and cross clamping through the surgical opening and cardiolplegia in the aortic root. Than after positioning the small rtetractor the mitral repair is peformed as usual.
RESULTS: In 335 patient scheduled for mimimally invasive mitral repair with this technique we had three conversion to sternotomy (1%) at the beginning of our experience. In 312 (93%) cases was possible to proceed with a direct aortic cannulation. In 99% of the patients we had a good or optimal visualisation of the whole mitral apparatus. All patients had a good myocardial protection.
CONCLUSIONS: Minimally invasive mitral valve repair via the third intercostal space with direct aortic cannulation has some advantages because reproduce the standard operation but less invasive. The surgical exposure may be better than through the fourth space particularly for the treatment of A3 and P3 prolaps or posterior commissure.


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