Lower Ministernotomy: An Approach for Treating All Valvulopathies?

Background: Lower ministernotomy offers the advantage of providing excellent visualization of the 4 cardiac cavities, thus allowing surgical treatment of the aortic, mitral, and tricuspid valves as well as any intracavitary procedure. Information on technical issues, as well as safety and echocardiographic results of this approach, are sparse. The aim of this retrospective study was to describe outcomes of lower ministernotomy to treat valvulopathies and for other intracardiac surgical procedures.

Methods: All consecutive patients aged more than 18 years who underwent cardiac surgery by ministernotomy between January 2017 and March 2023 in our institution (Pitié-Salpêtrière Hospital, Sorbonne University, Paris, France) were included in this retrospective study. Main outcome variables were all-cause mortality, postoperative complications, and echocardiographic results.

Results: During the 6-year study period, 633 patients were treated through a lower ministernotomy. Among them, 338 patients had aortic valve surgery (AVS) with or without tricuspid annuloplasty (TA), 254 had mitral valve surgery (MVS) with or without TA, 25 had AVS and MVS with or without TA, and 38 had other types of intracardiac surgery. Hospital survival was 99.1% in the AVS group, 98.1% in the MVS with or without TA group, 96% in the AVS and MVS with or without TA group, and 97.4% in the other intracardiac surgery group. Only 1 patient required repeat osteosynthesis in the entire cohort, and 12 (2.1%) patients had mediastinitis. A total of 162 (25%) patients received transfusions, 11 patients (1.7%) had permanent strokes, and 49 (7.5%) underwent new pacemaker implantation.

Conclusions: Lower ministernotomy is a safe approach for treating all valvulopathies, separately or concomitantly, and other intracardiac diseases, and it is associated with a low rate of morbidity and mortality.