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Updated: Sep 20, 2026
Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Minimally invasive mitral valve repair suggests earlier operations for mitral valve disease
James P Greelish1, Lawrence H Cohn, Marzia Leacche
1Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
Objective:
We began minimally invasive mitral valve surgery in August, 1996, to reduce hospital costs, to improve patient recovery, cosmetic appearance, and to decrease trauma, yet maintain the same quality of surgery. To validate this approach we reviewed our entire experience through May 2002.
Methods:
From August 1996 to May 2002, we performed 413 minimally invasive mitral valve operations including 51 mitral valve replacements and 362 mitral valve repairs. Excluding 4 robotically assisted repairs, we evaluated 358 patients, using the mitral valve repairs as the basis for this retrospective survey. These operations were performed through a 6- to 8-cm minimally invasive incision, beginning with parasternal and, most recently, lower ministernotomy (181 patients). The mitral valve reparative techniques include repair of 94 prolapsed anterior leaflets, posterior leaflet resection, leaflet advancement, commissuroplasty, Polytetrafluoroethylene (PTFE; Gore-Tex, W. L. Gore & Associates, Inc, Flagstaff, Ariz) chordal placement, and ring annuloplasty. Cannulation sites varied but primarily utilized a miniaturized system of 24F catheters in both the inferior and superior venae cavae with assisted venous suction. The Cosgrove ring was used in 95% of the patients undergoing this procedure.
Results:
The operative mortality was 0/358. Perioperative morbidity included a 26% incidence of new atrial fibrillation, 2% incidence of pacemaker implantation, 0.5% incidence of deep sternal wound infection, and 1.9% incidence of stroke after an operation. There were 10 arterial and 3 venous complications. The mean length of stay was 6 days and 208 patients stayed < or =5 days. Only 25% of the patients underwent homologous blood transfusion. The mean follow-up was 36 months with 1.4% lost to follow-up. There were 12 late deaths and a survival at 5 years of 95%. There were 21 valves requiring reoperation for structural valve failure of 5.8%. The probability of freedom from reoperation at 5 years was 92%.
Conclusion:
This study documents the safety of minimally invasive mitral valve repair surgery in 358 patients. It also documents a low incidence of homologous blood use, requirement for post-hospital rehabilitation, and general morbidity.
Insights
Minimally invasive mitral valve repair surgery is safe and effective, demonstrating a 0% operative mortality and a 5-year survival rate of 95%. This approach reduces hospital stay and blood transfusions for patients undergoing mitral valve repair.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
- Mitral Valve Repair
Background:
- Minimally invasive mitral valve surgery was introduced to reduce costs, improve recovery, and enhance cosmetic outcomes while maintaining surgical quality.
- A comprehensive review of early surgical experiences was conducted to validate this approach.
Purpose of the Study:
- To evaluate the safety and efficacy of minimally invasive mitral valve repair surgery.
- To assess perioperative morbidity, long-term survival, and reoperation rates.
Main Methods:
- A retrospective review of 358 patients who underwent minimally invasive mitral valve repair between August 1996 and May 2002.
- Procedures utilized small incisions (6-8 cm) with various reparative techniques including leaflet repair, annuloplasty, and chordal replacement.
- Standardized cannulation and cardiopulmonary bypass techniques were employed, with 95% of patients receiving a Cosgrove ring.
Main Results:
- Zero operative mortality (0/358) was observed.
- Perioperative complications included new-onset atrial fibrillation (26%), pacemaker implantation (2%), deep sternal wound infection (0.5%), and stroke (1.9%).
- Mean hospital stay was 6 days, with 25% of patients receiving homologous blood transfusions. Five-year survival was 95%, with a 5.8% reoperation rate for structural valve failure and 92% freedom from reoperation at 5 years.
Conclusions:
- Minimally invasive mitral valve repair surgery is a safe and effective procedure.
- The technique is associated with a low incidence of homologous blood use, reduced need for post-hospital rehabilitation, and overall low morbidity.
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