Mitral Valve Replacement and Coronary Revascularization Via the Left Anterior Minithoracotomy

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This video demonstrates a novel surgical technique that combines minimally invasive coronary artery bypass grafting (CABG) and mitral valve replacement through a single approach: left anterior minithoracotomy in the fourth intercostal space.  

The authors present the case of a 74-year-old male with advanced three-vessel coronary artery disease, severe mitral valve regurgitation, and left ventricular dysfunction. Preoperative assessments revealed a low ejection fraction of 20 percent. The surgery involved peripheral cannulation for cardiopulmonary bypass, followed by a left anterior thoracotomy to achieve optimal exposure for both CABG and mitral valve replacement. 

Key procedural steps included a unique maneuver to enhance mitral valve access through the left anterior minithoracotomy. A saphenous vein graft was used to bypass the posterior descending and obtuse marginal arteries, while the left internal mammary artery (LIMA) was anastomosed to the left anterior descending artery (LAD). The mitral valve was replaced with a biological prosthesis. 

Postoperative evaluation confirmed excellent mitral valve function. The total surgery time was 360 minutes, with 254 minutes on cardiopulmonary bypass and 152 minutes of aortic cross-clamping. 

References

1. Babliak O, Lazoryshynets V, Demianenko V, Babliak D, Marchenko A, Revenko K, et al. New approach to the mitral valve through the left anterior minithoracotomy for combined valve and coronary surgical procedures. JTCVS Techniques. 2023 Dec; Available from: http://dx.doi.org/10.1016/j.xjtc.2023.11.015
2. Babliak O, Demianenko V, Marchenko A, Babliak D, Melnyk Y, Stohov O, et al. Left anterior minithoracotomy as a first-choice approach for isolated coronary artery bypass grafting and selective combined procedures. European Journal of Cardio-Thoracic Surgery. 2023 May 5; Available from: http://dx.doi.org/10.1093/ejcts/ezad182

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