Underarm Heart Surgery (Small Incision): Who Can Have It?

When heart valve surgery is mentioned, what usually comes to mind is the classic method in which the breastbone is opened right down the middle. Yet in suitable patients, especially in mitral and tricuspid valve surgery, we can perform the same repair without touching the breastbone at all, through a small incision made under the right armpit. In this article I will describe the underarm approach and for whom it is suitable.

What Is the Right Underarm (Mini Thoracotomy) Approach?

In this technique, through a 4-6 centimetre incision made between the ribs on the right side of the chest, we reach directly the right side of the heart, that is, the point from which the mitral and tricuspid valves are most easily seen. The heart-lung machine is connected via the groin or the neck, and we stop the heart and carry out the repair without touching the breastbone at all.

Which Heart Conditions Can Be Operated On Through the Underarm?

We use this approach most often in mitral valve repair and replacement, in tricuspid valve surgery, and in closing some simple structural and congenital defects (for example atrial septal defect). We can also carry out additional procedures such as atrial fibrillation ablation through this small incision in the same session.

Can the Small Incision Be Used in Severely Overweight Patients?

Excess weight alone does not rule out this method; however, we assess factors such as chest wall thickness, a history of lung disease and whether the groin and neck vessels are suitable for connection to the heart-lung machine, together with preoperative imaging. In those who have previously had right lung or chest surgery, this approach can become technically more difficult.

Frequently Asked Questions

Can underarm surgery be used in every valve disease? No; the most suitable candidates are mitral and tricuspid valve diseases. For the aortic valve, different small-incision techniques (such as upper mini sternotomy) are preferred.

Does this method take longer than the classic operation? Generally yes, the time for connection to the heart-lung machine and for the incision may be a little longer; but this difference is balanced by the reduced trauma and faster recovery.

Can it be applied to everyone? No; anatomical suitability is assessed with preoperative imaging, and in patients who are not suitable the classic method is preferred.

Conclusion

The underarm (mini thoracotomy) approach is an evidence-based technique that can be applied safely in the right patient without opening the breastbone. The decision on suitability is personalised according to the valve pathology and the patient’s anatomical features.

You can book an appointment for a detailed examination so that we can assess whether the underarm approach is suitable for you for your heart valve surgery.

References

1. Modi P, Hassan A, Chitwood WR Jr. Minimally Invasive Mitral Valve Surgery: A Systematic Review and Meta-Analysis. Eur J Cardiothorac Surg. 2008;34(5):943-952.
2. Cao C, Gupta S, Chandrakumar D, et al. A Meta-Analysis of Minimally Invasive Versus Conventional Mitral Valve Repair for Patients with Degenerative Mitral Disease. Ann Cardiothorac Surg. 2013;2(6):693-703.