Al Ganadi A, Al-Shameri I, Alwsabi N, Bashraheel S, Alwsabi N, Mohammed S, Al-Fakih W. Initial experience of minimally invasive triple valve surgery in a developing country. World J Surg Proced 2026; 16(2): 118325 [DOI: 10.5412/wjsp.118325]
Corresponding Author of This Article
Ismail Al-Shameri, MD, Department of Cardiovascular Surgery, Cardiovascular and Kidney Transplant Center, Al Ashbat Street, Taiz 00967, Yemen. ismailsamer@taiz.edu.ye
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Cardiac & Cardiovascular Systems
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research-article
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Al Ganadi A, Al-Shameri I, Alwsabi N, Bashraheel S, Alwsabi N, Mohammed S, Al-Fakih W. Initial experience of minimally invasive triple valve surgery in a developing country. World J Surg Proced 2026; 16(2): 118325 [DOI: 10.5412/wjsp.118325]
World J Surg Proced. Sep 16, 2026; 16(2): 118325 Published online Sep 16, 2026. doi: 10.5412/wjsp.118325
Initial experience of minimally invasive triple valve surgery in a developing country
Abudar Al Ganadi, Ismail Al-Shameri, Naseem Alwsabi, Salem Bashraheel, Nada Alwsabi, Shams Mohammed, Wadhah Al-Fakih
Abudar Al Ganadi, Department of Cardiovascular and Kidney Transplant, Cardiovascular and Kidney Transplant Center, Taiz 00967, Yemen
Ismail Al-Shameri, Naseem Alwsabi, Nada Alwsabi, Shams Mohammed, Wadhah Al-Fakih, Department of Cardiovascular Surgery, Cardiovascular and Kidney Transplant Center, Taiz 00967, Yemen
Salem Bashraheel, Department of Anaesthesiology, Cardiovascular and Kidney Transplant Center, Taiz 00967, Yemen
Author contributions: Al Ganadi A and Al-Shameri I contributed to study design, data analysis, and manuscript writing; Al-Shameri I, Alwsabi N, Mohammed S, and Al-Fakih W contributed to data collection; Bashraheel S contributed to anesthesia management and manuscript review; Alwsabi N prepared tables and figures; and all authors reviewed and approved the final manuscript.
Institutional review board statement: This study was approved by the Medical Ethics Committee of Cardiovascular and Kidney Transplantation Center, Taiz University, approval No. 081126.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
Corresponding author: Ismail Al-Shameri, MD, Department of Cardiovascular Surgery, Cardiovascular and Kidney Transplant Center, Al Ashbat Street, Taiz 00967, Yemen. ismailsamer@taiz.edu.ye
Received: January 6, 2026 Revised: January 23, 2026 Accepted: March 5, 2026 Published online: September 16, 2026 Processing time: 257 Days and 6.7 Hours
Abstract
BACKGROUND
Minimally invasive cardiac surgery for multivalvular heart disease remains technically demanding, particularly in resource-limited settings. Evidence regarding minimally invasive triple valve surgery (TVS) is scarce, especially from developing countries.
AIM
To evaluate the feasibility and early outcomes of minimally invasive concomitant TVS in a developing country.
METHODS
Four consecutive patients with severe multivalve pathology underwent minimally invasive cardiac surgery double valve replacement with tricuspid valve repair via a right mini-thoracotomy approach. Perioperative data, technical challenges, and short-term outcomes were analyzed.
RESULTS
All patients [mean age: 33 years (range 16-41), all male] underwent successful procedures. Mean cardiopulmonary bypass time was 257.5 minutes (range 200-320), and aortic cross-clamp time was 149 minutes (range 114-195). No intraoperative complications occurred. Postoperative ventilation time averaged 5.7 (range 3-12) hours, ICU stay 1.25 (range 1-2) days, and hospital stay 5.5 (range 4-8) days. One patient has postoperative atrial fibrillation. There were no mortalities at 30 days. Postoperative echocardiography showed well-seated prosthetic valves and competent tricuspid valves in all cases.
CONCLUSION
Minimally invasive concomitant TVS is feasible and safe in selected patients, even in resource-limited settings.
Core Tip: Minimally invasive triple valve surgery is rarely reported, particularly in developing countries with limited resources. This retrospective study presents the early experience with concomitant minimally invasive aortic and mitral valve replacement, combined with tricuspid valve repair, via a right mini-thoracotomy. Despite prolonged operative times, the procedure demonstrated excellent early outcomes, no mortality, and rapid postoperative recovery. These findings support the feasibility of minimally invasive multi-valve surgery in carefully selected patients, even in resource-constrained environments.
