Aorto-mitral prosthesis from right-sided mini-thoracotomy: the first case in the Russian Federation

Introduction. The development of minimally invasive surgery and the publication of long-term favorable outcomes contribute to the expanding use of these techniques. Compared to the conventional median sternotomy, minimally invasive valve surgery offers reduced blood loss, less postoperative pain and complications, and faster recovery with shorter stay in the ICU and hospital. Despite the lack of domestic publications, individual cases of mitral and aortic valve repair via right mini-thoracotomy have been described around the world. This paper presents the experience of a successful simultaneous prosthetic replacement of both valves through this approach in a 53-year-old female patient. Aim: To evaluate the feasibility of using minimally invasive techniques (right mini-thoracotomy) for surgical treatment of combined mitral and aortic valve disease. Material and Methods. At the Department of Cardiovascular Surgery of Sechenov University (Moscow), a novel approach – right mini-thoracotomy – was tested for treating a 53-year-old female patient with combined mitral and aortic valve pathology. Given her professional involvement in sports, preserving the integrity of the chest wall and avoiding sternotomy was a key consideration. This method helped reduce complication risks and accelerated recovery. Results. The surgery demonstrated technical features and advantages of the minimally invasive approach. Right mini-thoracotomy in double valve surgery reduces surgical trauma, the incidence of respiratory and infectious complications, bleeding, postoperative pain, and the duration of mechanical ventilation. A lower rate of atrial fibrillation and improved cosmetic outcomes were also observed. An additional benefit was the shorter ICU and hospital stay, resulting in decreased treatment costs. Conclusion. Right mini-thoracotomy for double valve surgery poses no significant difficulties when the surgeon is experienced in single-valve interventions. The outcomes are comparable to those of the standard sternotomy approach. Randomized multicenter studies are needed to objectively confirm the advantages of this technique.