Transaxillary Direct-View Double Valve Surgery: A Step-by-Step Procedural Guide

The transition toward minimally invasive cardiac surgery is no longer solely about reducing incision size; it is about creating a standardized, versatile, and sustainable concept. The direct-view transaxillary approach represents a significant evolution that is ready for widespread clinical adoption. It provides a simplified surgical setup that enhances the experience for both patients and surgeons.

By reducing the reliance on specialized, expensive technology—performed under direct vision—while maintaining excellent technical outcomes, the transaxillary approach makes minimally invasive surgery more accessible to a broader range of surgeons in various healthcare environments. Furthermore, this approach minimizes tissue trauma and invasiveness, allowing for “ultrafast-track” protocols and perfectly fitting into modern Enhanced Recovery After Surgery (ERAS) protocols.

In this video, the authors present a case of a double-valve intervention and left atrial appendage occlusion performed on a male patient who suffered from severe aortic and mitral regurgitation and permanent atrial fibrillation.

This video submission is from the 2026 CTSNet Instructional Video Competition. Stay tuned to CTSNet.org and the CTSNet YouTube channel in the coming weeks to watch all entries from the competition, including the winning videos.  

References

1. Simplified approach for minimally invasive mitral valve surgery through a trans-axillary mini-thoracotomy access. Malvindi PG, Bifulco O, Spagnolo F, Galeazzi M, Berretta P, Cefarelli M, Wilbring M, Zingaro C, Kappert U, Di Eusanio M. Ann Thorac Surg. 2025 Nov 17:S0003-4975(25)01113-0. doi: 10.1016/j.athoracsur.2025.10.037. Epub ahead of print. PMID: 41260487.
2. The transaxillary concept for minimally invasive isolated aortic valve replacement: results of 1000 consecutive patients. Wilbring M, Arzt S, Taghizadeh-Waghefi A, Petrov A, Di Eusanio M, Matschke K, Alexiou K, Kappert U. Eur J Cardiothorac Surg. 2024 Nov 28;66(6):ezae427.
3. Minimally Invasive Trans-Axillary versus Full Sternotomy Mitral Valve Repair: A Propensity Score-Matched Analysis on Mid-Term Outcomes. Bifulco O, Malvindi PG, Berretta P, Brugiatelli L, Cefarelli M, Alfonsi J, D’Alfonso A, Zingaro C, Di Eusanio M. Medicina (Kaunas). 2023 Dec 23;60(1):29.

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