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Evolution of Minimally Invasive Mitral Valve Repair: 30-Year Experience From a High-Volume Center

Jagdip Kang1, Mateo Marin-Cuartas1, Philipp Kiefer1

  • 1University Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany.

Annals of Thoracic Surgery Short Reports
|December 22, 2025
PubMed
Abstract

Insights

Minimally invasive mitral valve repair (MVr) outcomes have significantly improved over decades. Both isolated MVr and combined tricuspid valve (TV) surgery show enhanced long-term survival, demonstrating the procedure

Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Cardiac Surgery
  • Valvular Heart Disease

Background:

  • Minimally invasive mitral valve repair (MVr) is a standard procedure, often combined with tricuspid valve (TV) surgery.
  • Limited evidence exists on the long-term outcomes and their evolution over time for these combined procedures.
  • This study investigates improvements in outcomes for minimally invasive MVr, both isolated and with concomitant TV surgery, over several decades.

Purpose of the Study:

  • To evaluate the long-term survival trends following minimally invasive mitral valve repair (MVr).
  • To assess the evolution of outcomes for minimally invasive MVr performed with or without concomitant tricuspid valve (TV) surgery.
  • To determine if surgical outcomes have improved over different time periods.

Main Methods:

  • Retrospective analysis of 5559 patients undergoing minimally invasive MVr between 1996 and 2023.
  • Patients were categorized into five surgical periods from 1996-2001 to 2020-2023.
  • Primary outcome was 10-year survival; subanalysis included patients with concomitant TV surgery.

Main Results:

  • 30-day mortality decreased from 1.1% in 1996-2001 to 0.3% in 2020-2023.
  • 10-year survival improved from 68.1% (1996-2001) to 83.7% (2014-2019).
  • For concomitant TV surgery, 1-year and 10-year survival rates significantly improved across periods.

Conclusions:

  • Minimally invasive MVr, alone or with TV surgery, is a safe and reproducible approach.
  • The procedure is associated with low complication rates and infrequent conversion to sternotomy.
  • Excellent early and long-term survival rates have been achieved and improved over time.

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