BACKGROUND: Concerns still exist regarding increased technical complexity and longer operative times associated with minimally invasive cardiac procedures. To help overcoming this view and the skepticism about the value of performing cardiac surgery through reduced incisions, we present and discuss our experience with a simplified minimally invasive surgical setup using a right trans-axillary mini-thoracotomy direct view access.

METHODS: This is a retrospective study based on institutional database and including consecutive patients who underwent trans-axillary mitral valve surgery from January 2017 to December 2024.

RESULTS: The study included 615 patients. Mitral valve repair for degenerative disease was performed in 94%, tricuspid valve surgery was associated in 16%. Mean cardiopulmonary bypass and cross-clamp times were 105 ± 32 and 65 ± 23 minutes, respectively. Thirty-day mortality and stroke/TIA rates were 0.3% and 0.9%. Median postoperative intubation time was 2 [0-6] hours, with 51% extubated in theatre. Median ICU and hospital stays were 24 [22-48] hours and 7 [6-8] days. Residual mitral regurgitation was none/mild in 98% of repaired patients; recurrent regurgitation ≥ moderate occurred in 1.4% at 1 year and 11% at 5 years. Survival probabilities at 1 and 6 years were 99% and 96%.

CONCLUSIONS: Minimally invasive mitral surgery through trans-axillary approach ensures outstanding technical results with low risk of perioperative complications. Increasing the perceived value of minimally invasive procedures through a simplified surgical setup can facilitate the initiation and wider adoption of a minimally invasive program.