Figure.

Postoperative result to illustrate surgical access in different minimally invasive procedures

1. Patient, 5 days after aortic valve reconstruction. Access through the second intercostal space is particularly suitable for isolated aortic valve replacement if the aorta takes a convex right course

2. Patient, 6 weeks after mitral valve reconstruction for posterior leaflet prolapse. Anterolateral access through the fourth intercostal space is an option for most mitral or tricuspid valve procedures.

3. Patient, 6 days after aortic valve replacement for stenosis and mitral valve reconstruction in for anterior leaflet prolapse. Anterolateral access through the second or third intercostal space provides access to all valves (except the pulmonary valve) if the aorta takes a convex right course.

4. Intraoperative photograph of a surgical site in minimally invasive triple bypass surgery through a left anterolateral minithoracotomy. Deep down the aorta is visible with the already placed anastomoses of a radial artery (a) and a leg vein (b). The microclamp that is secured with a rubber band in the right margin of the photo sits on the left internal mammary artery (LIMA) (c). The patient underwent a triple bypass operation, with the LIMA grafted to the left anterior descending (LAD) artery, the radial artery to the circumflex artery, and the vein to the interventricular posterior branch of the right coronary artery.