Beijing Anzhen Hospital: Surgical Logic Behind Single-Incision Minimally Invasive Triple Valve Surgery
Beijing Anzhen Hospital: Surgical Logic Behind Single-Incision Minimally Invasive Triple Valve Surgery
Diagnostic Challenges
🔬 A 66-year-old male presented with severe exertional dyspnea and chest tightness.
📊 The patient had a 50-year history of heavy smoking, resulting in borderline preoperative pulmonary function.
🫀 Echocardiography revealed typical rheumatic combined valvular disease.
📉 Specific hemodynamics showed moderate mitral stenosis with moderate regurgitation, moderate aortic stenosis with severe regurgitation, and severe tricuspid regurgitation.
Surgical Nuances
⚙️ Facing the need for simultaneous triple-valve intervention, we abandoned the traditional median sternotomy.
🔪 The procedure was performed via a single 6cm right mini-thoracotomy through the third intercostal space under general anesthesia.
🩸 The core logic was to establish cardiopulmonary bypass via peripheral vessels, reserving the precious 6cm thoracic window entirely for the heart.
🧵 The sequence of valve intervention was critical to the success of this operation.
💡 Following aortic cross-clamping, we first opened the left atrium to resect the rheumatic mitral valve and implant the prosthesis.
🔧 We then addressed the shallower aortic root to complete the aortic valve replacement.
⚖️ This deep-to-shallow strategy prevented the implanted aortic prosthesis from obscuring the surgical field for the mitral valve.
🪡 Finally, the right atrium was opened to perform tricuspid annuloplasty for severe regurgitation, restoring right ventricular geometry.
Clinical Pearls
🧠 For patients with a heavy smoking history, preserving sternal integrity is the anatomical foundation for avoiding postoperative ventilator dependence.
⏱️ Addressing three valves simultaneously within a narrow tubular visual field demands exceptional spatial orientation and microscopic suturing skills with long-shaft instruments.
🎯 The total operative time was strictly controlled at 5.07 hours, effectively minimizing myocardial ischemia time.
Outcomes & Media
🏥 The patient maintained extreme hemodynamic stability and was successfully extubated 20 hours postoperatively.
🚶♂️ He met discharge criteria on postoperative day 5.
🎥 The attached images demonstrate the extreme preoperative echocardiographic data and the healing details of the 6cm minimally invasive incision.