Navigating anatomical challenges of minimally invasive mitral valve replacement in a patient with severe scoliosis

Minimally invasive mitral surgery is increasingly preferred due to reduced trauma and faster recovery. However, its technical complexity is exacerbated in patients with anatomical anomalies like scoliosis, affecting up to 8.3% of the elderly population. Severe scoliosis causes significant thoracic distortion and alters the positioning of cardiovascular structures, complicating access, visualization, and instrumentation. These factors make minimally invasive mitral valve replacement more complex, as this approach relies on optimal exposure of the mitral valve through a limited incision. We present the case of a 71-year-old female with severe scoliosis undergoing minimally invasive mitral valve replacement with a mechanical prosthesis and septal myectomy. Access was achieved via a 5 cm right mini-thoracotomy in the second intercostal space. This case report discusses the surgical challenges encountered and the unique considerations and adjustments required in performing cardiac surgery in patients with altered thoracic anatomy, and the importance of preoperative assessment and intraoperative flexibility.