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BACKGROUND Our aim is to present the technique for simultaneous mitral valve (MV) surgery and coronary artery bypass grafting (CABG)using a minimally invasive approach through a single minithoracotomy. METHODS Between October 2020 and June 2023 we operated on 34 non-consecutive patients, in whom we performed simultaneous procedures involving the MV and CABG via left anterior minithoracotomy. The average age of the patients was 65.3 years, mean body surface area (BSA) - 1.92 and a mean left ventricular ejection fraction - 42.9%. Preoperative CT angiography was routinely carried out. Operation performed with peripheral cardiopulmonary bypass, aortic crossclamping and cold blood cardioplegia. The surgical access was 6 to 8 cm incision in the 4th intercostal space (ICS) on the left anterior side. Access to the MV was through the right atrial and transseptal incision. Standard techniques for MV repair/replacement were employed. MV repair/replacement was performed after distal anastomoses, only LIMA graft was anastomosed after MV surgery. RESULTS Successful MV visualization was achieved in all patients, and the planned procedures were performed without conversion to sternotomy in all patients. 32 individuals (94%) underwent MV repair, MV replacement was performed in 2 patients (6%). Conventional surgical instruments were used in 19 cases (55.9%), long-shafted instruments - in 15 cases (44.1%). A knot-pusher was required in 11 instances (32.4%). A CT distance from the skin level to the posterior annulus of the MV is 12.7 ± 1.4 cm (9.5-16.8). Complete concomitant revascularization was successfully achieved in all cases, with an average of 2.56 ± 0.8 (1-4) distal anastomoses per patient. The mean total operation time was 336 ± 44 minutes (245-420), cardiopulmonary bypass (CPB) time - 225 ± 36.8 minutes (160-316), cross-clamp time - 127.4 ± 23 minutes (80-169). The average length of stay in the intensive care unit was 1.74 ± 0.67 days (1-4), the total hospital stay - 6.6 ± 2.2 days (4-14). Notably, there were no cases of bleeding requiring revision, strokes, or other major complications, and no instances of hospital or 30-day mortality. CONCLUSIONS Performing MV surgery through the left anterior thoracotomy and transseptal approach is a valuable and efficient technique for simultaneous procedures conducted via a single minithoracotomy incision. [ABSTRACT FROM AUTHOR]

Right axillary transverse minithoracotomy is not conventionally used for ventricular septal defect (VSD) repair because of complicated VSD exposure and the need for a temporary tricuspid valve leaflet detachment to facilitate VSD exposure. Recently, our team developed a new, not previously described surgical maneuver that markedly facilitates perimembranous VSD exposure without any need for tricuspid valve leaflet detachment. The above-mentioned VSD exposure maneuver was used in 21 patients with a median age of 5 months (range, 1.5 to 132 months) and a median body weight of 7 kg (range, 4 to 47 kg). The length of the incision varied from 3 to 4.5 cm over the fourth intercostal space within the anterior and posterior axillary lines. Central cardiopulmonary bypass cannulation and antegrade blood cardioplegia were performed in all patients. Bent/angled instruments were used throughout the procedure to facilitate the surgeon's view. Pericardial sutures and suspension of tricuspid valve chords were used as general exposure maneuvers. A special surgical maneuver aimed at changing the general plane of the ventricular septum was used. It consisted of one intraventricular exposing suture. Sufficient exposure of perimembranous VSD was obtained in all patients and was comparable with what is usually obtained through the median sternotomy. With the use of this new maneuver, all perimembranous VSDs could be safely exposed and repaired with the conventional suturing technique through the right axillary transverse minithoracotomy starting from 2 months of age.