Mitral valve surgery can now routinely be performed endoscopically

Background - There is an increasing interest in minimally invasive cardiac surgery. Methods and Results - Since February 1, 1997 till April 1, 2002, 306 patients underwent endoscopic mitral valve surgery ( 226 repair, MVP; 80 replacement, MVR). Predominant valve pathology was degenerative in MVP (83.6%) and rheumatic in MVR (65%). Mean age was 61.5 +/- 12.9 years. Median preoperative functional class ( MVP + MVR) and mitral regurgitation ( MVP) were II and 4 +. Statistical analysis included Kaplan-Meier and Cox regression methods. Mean follow-up was 19.6 +/- 17.3 months and complete. The procedure was successfully performed in all but 6 patients. Hospital mortality included 3 patients (1%) and was technology related in one. Postoperative morbidity included aggressive re-exploration (8.5%), new onset atrial fibrillation (17.0%), and pacemaker implantation (2.3%). There were 1 early and 10 late reoperations, 5 of which were because of endocarditis. Freedom from mitral valve reoperation at 4 years was 91 +/- 3.5%. No risk factors for reoperation could be detected. Echocardiographic follow-up showed a median degree of mitral regurgitation ( MVP) of 0 and a small paravalvular leak in four patients ( MVR). Ninety-four percent of the patients reported no or mild postoperative pain and 99.3% felt they had an esthetically pleasing scar. Ninety-three percent would choose the same procedure again and 46.1% were back at work within 4 weeks. Conclusions - Endoscopic mitral valve surgery can be performed safely but definitely requires a learning curve. Good results and a high patient satisfaction are guaranteed. It is now our exclusive approach for isolated atrioventricular valve disease.