The Transaxillary Access for Minimally Invasive Valve Surgery is Safe and Effective in Selected Patients with Native Valve Endocarditis

All articles of this category (opens in new window) Background: Minimally invasive techniques are increasingly applied in the treatment of infective endocarditis. Transaxillary access represents a novel surgical approach, but evidence regarding its safety and efficacy remains limited. We evaluated outcomes of patients undergoing transaxillary surgery for native aortic and mitral valve endocarditis compared with a conventional sternotomy cohort. Methods: Between 2021 and 2024, all consecutive patients undergoing surgery for infective endocarditis at our institution were screened. Exclusion criteria were extensive abscess formation, redo procedures, right-sided endocarditis, and concomitant bypass surgery. Of 316 patients, 179 (56.7%) met the inclusion criteria and were stratified into a transaxillary ( n = 81) and a sternotomy group ( n = 98). Results: Patient age was 63.0 vs. 64.5 years, p = 0.49 in the transaxillary and sternotomy cohorts, and gender distribution was similar. Transaxillary patients had lower risk scores (EuroSCORE II 2.98% vs. 6.24%, p < 0.001). Multivalve procedures were more frequent with sternotomy patients— n = 3 (3.7%) vs. n = 23 (23.5%), p < 0.001. Postoperative outcomes were comparable, except for shorter intensive care unit stay (2 vs. 4 days, p < 0.001), reduced ventilation time (6 vs. 12 hours, p < 0.001), and less frequent renal failure in the transaxillary cohort. Transaxillary patients had noninferior 30-day (92.6% vs. 78.4%) and long-term survival at 3 years (81.2% vs. 68.0%; p < 0.01). Rates of recurrent endocarditis did not differ— n = 5, 6.2% vs. n = 6, 6.1%, p = 1.00. Conclusion: In selected patients, transaxillary minimally invasive surgery provides noninferior survival compared with sternotomy, without sacrificing procedural safety. A comprehensive diagnostic approach is essential to exclude patients who need extensive reconstructive surgery. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany