- Several surgical approaches exits, the choice of which depends on the given clinical situation.
- Left Thoracotomy through the fourth intercostal space was used for closed mitral commisurolysis and commissurotomies.
- Short Right Thoracotomy is preferred for minimally invasive mitral surgery
- Right-sided anterolateral thoracotomy is preferred in redo mitral surgery
- Right- or left-sided thoracotomy
- This is best performed without aortic cross clamping on a beating heart.
- This avoids the risk of right ventricular injury in re sternotomies.
- Avoids the need to dissect a patent LIMA graft
- Maintains normal coronary perfusion.
- Aortic incompetence has to be ruled out beforehand.