Right infra-axillary mini-thoracotomy for aortic valve replacement.

Minimally invasive aortic valve replacement (MICSAVR) has traditionally been performed through forechest approaches, including partial sternotomy, parasternal thoracotomy, or anterior inter-costal thoracotomy (1-3). Proximity to the ascending aorta and aortic valve seems to be advantageous in these approaches. Fore-chest skin incisions are not necessarily ideal, as minimally invasive surgery may be preferred over standard sternotomy for cosmetic reasons. However, fore-chest wounds can easily be recognized and their dimensions determined. Second, incisions in fore-chest skin tend to lead to hypertrophic scarring, as is the case in the shoulder or pubic regions. Meanwhile in minimally invasive mitral valve surgery, the antero-lateral thoracotomy is now a standard procedure irrespective of its remoteness from the mitral valve. Right antero-lateral or lateral thoracotomy is cosmetically better because the wound can be hidden by the breast or arm, and those areas are not susceptible to scar formation. We started right infra-axillary mini-thoracotomy for minimally invasive AVR (TAX-AVR) as previously reported (4). Its cosmetic superiority over standard sternotomy was apparent, and remoteness from the ascending aorta was compensated for by using longshafted minimally invasive instruments and high definition endoscopic assist.