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

Heart valve disease can be presented extensively and this may cause a double (mitral-aortic, mitral-tricuspid), or a triple (mitral, aortic and tricuspid) valvular regurgitation. The surgical correction of important 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 of the patients. Here, we attempt to present a minimally invasive approach for the surgery of a 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 was performed in our department using this technique, since the minimally invasive approach through a right single-access thoracotomy became our choice for all isolated mitral valve and for most of isolated aortic valve replacement procedures. Triple valve surgery was performed in six cases until now and was feasible in all selected patients.