Heart valve disease can be extensive and may include double (mitral-aortic, mitral-tricuspid), or triple (mitral, aortic, and tricuspid) valvular regurgitation. The surgical correction of significant valvular regurgitation usually consists of the repair or replacement of all valves affected by a pathologic process. The median full-length sternotomy still serves as a classic approach for single, double, and triple valve operations in most patients. Here, we present a minimally invasive approach for the surgery of double and triple heart valve disease through a limited single-access right minithoracotomy in the 3rd intercostal space, with central aortic and percutaneous venous cannulation. A total of 48 double valve procedures were performed in our department using this technique. The minimally invasive approach through a right single-access thoracotomy has become our choice for all isolated mitral valve, and for most isolated aortic valve, replacement procedures. Triple valve surgery was performed in six cases and was feasible in all selected patients.

Two male patients who underwent an aortic valve replacement are presented in this study. After assessment, an aortic valve stenosis was diagnosed in both patients, and a multislice computed tomography scan confirmed the heavily calcified aorta and severe aortic stenosis. The computed tomography scan demonstrated the huge calcium deposits and their distribution in detail. Notably, the ascending aorta in both patients was severely plaqued, and only the supra-annular zone was free from any detectable calcium deposits. We present the images of this case and the surgical technique applied in this matter.

Partial detachment of intracardiac prosthesis is a common reality in cardiac surgical practice. Its identification and surgical correction can be very crucial for a patient, as well as for the surgeon. In this paper, we report a case of a 30-year-old man with partial detachment of mechanical mitral valve prosthesis. He recently underwent his seventh heart surgery procedure; five of them were caused by recurrent dehiscence of mitral valve prosthesis.

Historical Pages neuralgia, and patient satisfaction was improved with EVH compared with CVH. Operative time was significantly increased (WMD 15.26 min; 95% CI 0.01, 30.51), length of hospital stay was reduced (WMD -0.85 days; 95% CI -1.55, -0.15), and so were readmissions (ORs0.53; 95% CI 0.29-0.98).Reed w8x conducted a meta-analysis comparing leg wound infections following MIVH and CVH techniques. This showed a significant reduction in wound infection rates in favour of the MIVH group (ORs0.19; 95% CI 0.14-0.25). Similarly, wound healing disturbance rates were significantly improved with MIVH technique (ORs0.26; 95% CI 0.20-0.34).Rao et al. w9x performed a meta-analysis of cost-effectiveness of MIVH. They estimated the health-related quality of life utility (HRQoL) on discharge to be 0.9443 after MIVH and 0.6815 after CVH. Six weeks postoperatively, the utility was 0.9599 after MIVH and 0.8219 after CVH. By using these calculated utility estimates, they suggested that MIVH is a cost-effective alternative to CVH techniques. The incremental cost-effectiveness ratio (ICER) of $19,858.87yquality adjusted life year (QALY) compares favourably with other health care interventions. Probabilistic sensitivity analysis demonstrated with a 95.6% certainty that MIVH was the most cost-effective technique at a cost-effectiveness threshold of $50,000yQALY. Clinical bottom lineWe conclude that EVH reduces the level of postoperative pain, length of hospital stay and wound complication, with a high level of patient satisfaction, but a sub-analysis of a large randomised control trial has recently called into question the medium-to long-term patency of grafts endoscopically harvested. Referencesw1x Dunning J, Prendergast B, Mackway-Jones K. Towards evidence-based medicine in cardiothoracic surgery: best BETS. Interact CardioVasc Thorac Surg 2003;2:405-409. w2x versus open vein-graft harvesting in coronary artery bypass surgery. N Engl J Med 2009;361:235-244. w3x Burris N, Schwartz K, Brown J, Kwon M, Pierson III R, Griffith B, Poston R. Incidence of residual clot strands in saphenous vein grafts after endoscopic harvest. Innovations 2006;1:323. w4x Athanasiou T, Aziz O, Al-Ruzzeh S, Philippidis P, Jones C, Purkayastha S, Casula R, Glenville B. Are wound healing disturbances and length of hospital stay reduced with minimally invasive vein harvest? A metaanalysis. Eur J Cardiothorac Surg 2004;26:1015-1026. w5x Allen K, Cheng D, Cohn W, Connolly M, Edgerton J, Falk V, Martin J, Pharm D, Ohtsuka T, Vitali R. Endoscopic vascular harvest in coronary artery bypass grafting surgery: a consensus statement of the International Society of Minimally Invasive Cardiothoracic Surgery (ISMICS) 2005. Innovations 2005;1:51. w6x Yun KL, Wu Y, Aharonian V, Mansukhani P, Pfeffer TA, Sintek CF, Kochamba GS, Grunkemeier G, Khonsari S. Randomized trial of endoscopic versus open vein harvest for coronary artery bypass grafting: sixmonth patency rates. J Thorac Cardiovasc Surg 2005;129:496-503. w7x Cheng D, Allen K, Cohn W, Connolly M, Edgerton J, Falk V, M...

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