5th International Conference on Heart and Cardiovascular Diseases

Georgi Vasilev, PhD, is affiliated with the Department of Cardiac Surgery at Acibadem City Clinic Tokuda Hospital, Sofia, Bulgaria. His professional and research interests focus on cardiac surgery

Background: Minimally invasive cardiac surgery (MICS) has become an established alternative to median sternotomy, particularly in elderly and high-risk populations. The right transaxillary approach offers a bone-sparing, cosmetically superior entry point without compromising surgical exposure.

Objectives: To evaluate the clinical safety, efficacy, and outcomes of the right transaxillary approach in single and multi-valve procedures.

Methods: Over an 12-month period, 38 patients underwent valve surgery via a right anterolateral mini-thoracotomy (2nd/3rd/4th intercostal space). The cohort included 15 aortic valve replacements (AVR), 16 mitral valve replacements (MVR), 3 isolated tricuspid valve procedures (TVP), and 4 combined mitral-tricuspid interventions. AVR cases were predominantly performed using sutureless bioprostheses (Perceval S). All operations were guided by transesophageal echocardiography (TEE) with peripheral femoral cannulation.

Results: The mean patient age was 64 years. The mean aortic cross-clamp time was 60 minutes for AVR and 72 minutes for MVR. Isolated tricuspid procedures were successfully executed on a beating heart. Patients demonstrated favorable postoperative recovery with short intensive care unit (ICU) stays (All patients spent less than 24 hours in the ICU) and low complication rates. No conversion to median sternotomy was required.

Conclusion: The right transaxillary approach, combined with sutureless valve technology where applicable, is a safe, versatile, and effective technique for single and multi-valve cardiac interventions. It provides excellent hemodynamics and rapid patient recovery