{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T11:15:51Z","timestamp":1780917351519,"version":"3.54.1"},"reference-count":11,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T00:00:00Z","timestamp":1780876800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Minimally invasive valve surgery via right minithoracotomy is well established for isolated aortic and mitral procedures, but its application to multivalve operations remains uncommon and clinical data are scarce. We report our initial single-center experience with minimally invasive multivalve surgery\u2014defined as a small skin incision without rib spreading or internal mammary artery dissection\u2014in patients with combined aortic and mitral disease. Methods: We retrospectively analyzed 10 consecutive patients who underwent minimally invasive multivalve cardiac surgery at our institution. All operations were performed through a 5\u20137 cm right minithoracotomy in the third or fourth intercostal space, with femoral cannulation for cardiopulmonary bypass (CPB). Nine patients underwent a double-valve procedure (aortic and mitral) and one a triple-valve procedure (aortic, mitral, and tricuspid). Operative variables, perioperative complications, and early echocardiographic outcomes were assessed. Results: The mean age of patients was 69.8 \u00b1 5.2 years and 60% were female. Mean CPB and aortic cross-clamp times were 197.6 \u00b1 48.3 min and 148.1 \u00b1 34.7 min, respectively. All procedures were completed via the minimally invasive approach, with no conversion to sternotomy and no in-hospital deaths. No rethoracotomies, wound infections, or peripheral vascular complications occurred. Postoperative atrial fibrillation, observed in five patients (50%), was the most common complication. Early echocardiography showed good valve function in nine patients (90%); one had a moderate aortic paravalvular leak managed conservatively. Conclusions: In a center with established experience in single-valve minimally invasive surgery, multivalve procedures can be safely extended to a right minithoracotomy approach, with low perioperative morbidity and no early mortality despite operative times reflecting the early learning curve.<\/jats:p>","DOI":"10.3390\/jcm15124424","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T10:04:14Z","timestamp":1780913054000},"page":"4424","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Expanding the Boundaries of Minimally Invasive Cardiac Surgery: Initial Experience with Multivalve Procedures"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9786-6390","authenticated-orcid":false,"given":"Wojciech","family":"Karolak","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, Faculty of Medicine, Medical University of Gda\u0144sk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7739-0340","authenticated-orcid":false,"given":"Aleksandra","family":"Sta\u0144ska","sequence":"additional","affiliation":[{"name":"Division of Quality of Life Research, Department of Psychology, Faculty of Health Sciences, Medical University of Gda\u0144sk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6169-6942","authenticated-orcid":false,"given":"Igor","family":"Tomczyk","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Faculty of Medicine, Medical University of Gda\u0144sk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrzej","family":"Klapkowski","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Faculty of Medicine, Medical University of Gda\u0144sk, 80-210 Gdansk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,8]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1016\/j.jacc.2010.03.053","article-title":"Minimally-Invasive Valve Surgery","volume":"56","author":"Schmitto","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1016\/j.jtcvs.2014.01.046","article-title":"Mitral Valve Surgery: Right Lateral Minithoracotomy or Sternotomy? A Systematic Review and Meta-Analysis","volume":"148","author":"Sromicki","year":"2014","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1080\/17434440.2021.1894925","article-title":"Mitral Valve Surgery: Current Status and Future Prospects of the Minimally Invasive Approach","volume":"18","author":"Kempfert","year":"2021","journal-title":"Expert Rev. Med. Devices"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"El-Sayed Ahmad, A., Salamate, S., Granov, N., Bayram, A., Sirat, S., Doss, M., Silaschi, M., Akhavuz, \u00d6., and Bakhtiary, F. (2024). First Experiences with Automated Annular Suturing Device in Totally Endoscopic Aortic and Mitral Valve Replacement. Interdiscip. Cardiovasc. Thorac. 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Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e63","DOI":"10.1016\/j.athoracsur.2021.10.026","article-title":"Three-Dimensional Endoscopic-Assisted Concomitant Mitral and Aortic Valve Surgery","volume":"114","author":"Hosoba","year":"2022","journal-title":"Ann. Thorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Zoni, D., Cresce, G.D., Hinna-Danesi, T., Benvegnu, L., Poddi, S., Gallo, M., Sella, M., and Salvador, L. (2023). Endoscopic aortic valve surgery in isolated and concomitant procedures. Interdiscip. Cardiovasc. Thorac. Surg., 36.","DOI":"10.1093\/icvts\/ivad101"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1177\/15569845241231808","article-title":"Pushing the Boundries in Totally Endocospic Cardiac Surgery: Combined Triple Valve Surgery and Ascending Aorta Replacement","volume":"19","author":"Salvador","year":"2024","journal-title":"Innovations"},{"key":"ref_11","first-page":"33","article-title":"Minimally Invasive Concomitant Aortic and Mitral Valve Surgery: The \u201cMiami Method\u201d","volume":"4","author":"Lamelas","year":"2015","journal-title":"Ann. Cardiothorac. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4424\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T10:49:06Z","timestamp":1780915746000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/12\/4424"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,8]]},"references-count":11,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["jcm15124424"],"URL":"https:\/\/doi.org\/10.3390\/jcm15124424","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,8]]}}}