Left-Side Approach to the Mitral Valve
Alberto Repossini MD, Igor N. Kotelnikov MD, Lucio Parenzan MD, Vincenzo Arena MD

Although the standard surgical approach to the mitral valve is accomplished from the right side through an incision posterior and parallel to the interatrial groove, a left-side approach should be reconsidered for its suitable exposure of the mitral valve. Eleven patients underwent mitral valve surgery via a left lateral minithoracotomy. Cardiopulmonary bypass was performed through the femoral artery and vein, with cardioplegic solution delivered through the ascending aorta. Mitral surgery was performed after direct aorta cross-clamping, including mechanical and bioprosthetic implants, redo operations, annuloplasties and repairs. An excellent view of the mitral valve, much better than is achieved with a standard approach from the right, was obtained in all cases. Optimal vision of the entire annulus, chordae tendineae, papillary muscles and aortic valve was possible, with a wider angle of vision and greater flexibility of movement. Mitral valve structures were also closer to the operator, making the procedure easier.