The population of patients requiring pulmonary valve replacement (PVR) following surgery of the right ventricular outflow tract during infancy is growing. Full conventional sternotomy is widely used for PVR, while left anterior minithoracotomy has been described only in selected cases. Our aim is to describe our early experience with upper left ministernotomy as a systematic approach for PVR in teenagers and adult patients.

From December 2019 to December 2021, 13 consecutive patients underwent PVR via ministernotomy at our institution. The indications were severe pulmonary regurgitation in 11 patients and severe conduit stenosis in 2 patients. Ten patients (76.9%) already had at least 1 sternotomy. Pulmonary homografts, stentless porcine bioprostheses or stented pericardial bioprostheses were implanted. Age at operation was 24.6 years old (17.6–38.4).

There were no deaths, no cardiac injuries and no conversions to full sternotomy. The 3rd intercostal space was the most frequently used for the leftward extension of the ministernotomy (Figure 1). In 6 patients (46.1%), a residual intracardiac shunt was present and aortic cross-clamping was necessary. Median cardiopulmonary bypass and cross-clamping times were 70 (64–105.5) and 50 (40–75) minutes, respectively. Median intensive care and hospital stays were 2 (1–2.5) and 7 (6–11) days, respectively. All patients are doing well after a median follow-up of 16.2 months (13.5–19.0).

Ministernotomy is a safe approach for PVR and redo PVR in teenagers and adults. This approach combines the advantages of minimally invasive surgery (expedited recovery) and those of a midline incision such as the access to the ascending aorta and the absence of additional scar in cases of redo PVR.