CONGRESS ABSTRACT

Emerging evidence upholds minimally invasive approaches as the foremost surgical intervention for heart valve diseases, addressing detriments associated with traditional cardiac surgery. Yet, the comprehensive adoption of minimally invasive coronary surgery is disproportionately low, not to mention concurrent coronary and valve procedures. Bilateral mini-thoracotomy (MT) has been suggested as a feasible and safe technique for diverse isolated cardiac procedures. In 2021-2023, 7 patients were treated with minimally invasive mitral repair (MVr) and direct coronary artery bypass (MIDCAB): age was 66±4 years, 5 were males, and EuroSCORE II (%) was 2.6±1.2. For the procedure, a double-lumen endotracheal tube was employed, and heparin was administered. The right internal jugular vein was cannulated percutaneously. The MIDCAB involved a anterolateral left MT at the fifth intercostal space (IS). The left internal thoracic artery (LITA) was harvested under direct vision using a retractor. Mini-pericardiectomy was performed to facilitate off-pump anastomoses on the left anterior descending artery using a stabilizer, along with intracoronary shunts. Transit time flowmetry was performed. A right groin incision exposed the femoral vessels for echo-guided cannulation as per Seldinger. Endoscopic MVr was accomplished via a right MT above the nipple, at the fourth IS. A soft-tissue retractor and trocars at the fourth and sixth IS enabled 3D thoracoscopy and CO2 insufflation. After adjusting for selective ventilation, the chest was accessed for pericardiectomy. An aortic needle inserted via the main incision facilitated cardioplegia delivery and aortic venting. Cardiopulmonary bypass was established and aortic clamping achieved by Chitwood clamp at the second IS. Cardioplegia was delivered with the LITA graft temporarily closed. All patients received ring annuloplasty, 4 had posterior leaflet resection, 3 neochordal repair, and 2 had concomitant monopolar ablation and linear left atrial appendage closure. All patients were discharged healthy, after graft evaluation via computerized tomography. We report favorable outcome, satisfactory surgical times, early mechanical ventilation discontinuation (4±2 hours) and discharge from intensive care unit (3±1 days). No patient died at follow-up (maximum 2 years). In conclusion, minimally invasiveness should be embraced to ensure acceptance among patients and favorable long-term results, even when facing multifactorial pathology.