Should a video-assisted mini-thoracotomy be the approach of choice for reoperative mitral valve surgery?

Although the first mitral valve commissurotomiesperformed by Harken and Bailey were carried outthrough a right thoracotomy, the traditional modernmitral valve surgery approach has been via a mediansternotomy (1,2). During the 1980s, several authors uti-lized the right thoracotomy as an alternative approachfor mitral valve surgery in a redo setting (3,4). Theintroduction of modern perfusion cannulae, minimallyinvasive surgical instruments, and video-assisted sur-gery has created a new alternative approach forpatients undergoing mitral surgery (5). The study aimwas to compare operative outcomes, using either aminimally invasive video-assisted (MIVA) mini-thora-cotomy or a redo median sternotomy (MS), in mitralvalve surgery patients who had undergone prior car-diac surgery.