Technical feasibility and mid-term outcomes of right mini-thoracotomy for double or triple heart valve surgery: a multicenter retrospective analysis.

Background: Minimally invasive cardiac surgery (MICS) through a right mini-thoracotomy is well established for isolated valve procedures, but its role in aortic valve replacement (AVR)-inclusive double or triple valve surgery is not well defined. We compared perioperative and mid-term outcomes of MICS versus conventional full sternotomy (FS) for AVR combined with mitral and/or tricuspid valve procedures. Methods: We retrospectively identified 203 adults (30 MICS, 173 FS) who underwent AVR-inclusive double or triple valve surgery at two tertiary centers between May 2015 and May 2025. Inverse probability of treatment weighting (IPTW) based on a 10-covariate propensity score was applied after restriction to the region of common support. Outcomes were compared on the weighted pseudo-population; adjusted differences were summarized with 95% confidence intervals (CIs), and mid-term survival and freedom from significant valvular regurgitation were assessed by weighted Kaplan-Meier analysis. Results: After IPTW, the 10 propensity-score covariates were better balanced (most standardized mean differences <0.15). Cardiopulmonary bypass (CPB) and aortic cross-clamp (ACC) times did not differ significantly between the MICS and FS groups (CPB 163.6 Conclusions: In this selected, non-randomized cohort, AVR-inclusive double or triple valve surgery was completed by MICS in all attempted cases, without a detectable increase in operative times and with shorter ventilation, ICU, and hospital stay. Mid-term survival and valve-related outcomes showed no statistically significant difference from FS.