الفهرس 
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Abstract
Over past decades, minimally invasive cardiac surgery has evolved dramatically, Since the mid-1990s cardiac surgery has shown a progressive and universally rising interest towards the development of minimal invasion and minimal access techniques which has became a standard approach in mitral valve surgery in many centers all over the world
MIMVS is not a simple approach, it is a complex of new techniques, operation and specific technologies MIMVS refers to a constellation of surgical techniques/technologies that minimize surgical trauma through smaller incisions compared with a conventional sternotomy.
Right thoracotomy approach to perform mitral valve surgery was described in 1954, various technical details of this approach have been changed and upgraded This incision presents favorable cosmetic results, representing good alternative in young female patients, As the scar almost invisible in the breast fold. This approach becomes more reproducible for all surgeons, being based on their conventional hand skills.
We outlined our initial experience with mitral valve replacement through right thoracotomy and demonstrates that minimally invasive mitral valve surgery is a feasible method that can be performed safely and effectively.
Our study included 36 patients with mitral valve disease who planned to have surgical intervention (mitral valve replacement) between January 2015 and December 2017, Skin incision was created under the breast fold starting 3 cm from the lateral border of the sternum The right chest cavity was entered through (the third or fourth) intercostal space, standard central aortic bicaval cannulation was performed, mitral replacement was done and tricuspid repair when indicated
The thoracotomy incisions in our experience ranged from (10 cm to15 cm) were bigger because we carried out the procedure under direct vision and not with a thoracoscope and because the complication of the femoral cannulation. we favoured direct central aortic bicaval cannulation , Our believe is that central aortic cannulation expands the suitability of minimally invasive mitral surgery to include those patients who have an absolute contraindication to femoral artery cannulation, although it is more challenging.
The most striking advantages of anterolateral mitral surgery are, the Less post-operative pain and a fast return to normal activity and more rapid respiratory recovery can be observed in the anterolateral thoracotomy compared with classic median sternotomy, Decreasing hospital stay and every patient could return back to his daily life without any aid in short time is the target of MIMVS, the cosmetic healing after anterolateral thoracotomy is excellent with absent of wound dehiscence and lower risks of wound infection.
Patient satisfaction and appreciation by the wound appearance, were high, because the wound is under the breast fold and completely hidden and they completed their life without this scar over the sternum which was a sure sign of cardiac surgery.
Cardiac surgery is not a simple surgery or one day surgery, it still one of sophisticated surgeries that needs many equipment and specialized man power with special instruments. All of that make mitral valve surgery is a costy surgery and efforts are given to reduce this cost without touching the efficacy of the maneuver or the experience of the team. This made our mission hard as we did not use any additional resources(video assistance & port access) and depend on our conventional instruments and machines the same we use in classic open heart surgery.
Conclusion
Right thoracotomy for mitral valve surgery using central aortic bicaval cannulation is reproducible and safe procedure, which is not only has excellent cosmetic result with it subsequent psychological satisfaction, but it also decreased the risks of femoral cannulation, decrease both hospital & ICU stay with rapid recovery. One of the most imported aspect in mitral valve surgery through limited right thoracotomy that it needs no additional resources rather than those in the conventional method mitral valve surgery.