Endoscopic Combined Aortic and Mitral Valve Surgery: Feasibility and Mid-term Outcomes

Endoscopic surgery has emerged as an evolution of minimally invasive approaches, but evidence regarding its application in combined valve procedures remains scarce. This study evaluates its feasibility and mid-term outcomes in concomitant aortic and mitral valve (MV) surgery.

We retrospectively analysed all consecutive patients undergoing endoscopic concomitant mitral and aortic valve (AV) surgery from January 2016 to July 2025. Cardiopulmonary bypass (CPB) was established via peripheral cannulation. All procedures were performed through a right mini-thoracotomy using a 30° thoracoscope. The primary end-point was in-hospital mortality. Secondary end-points included major postoperative complications, a composite early outcome (in-hospital mortality, stroke, major bleeding requiring revision, postoperative myocardial infarction, or dialysis), and mid-term survival. Univariable logistic regression was used to identify predictors of the composite early postoperative outcome. Follow-up was 100% complete.

The analysis included 111 patients (median age 70 years [interquartile range, IQR 62-76], 55 males, median EuroSCORE II 3.3 [IQR 1.90-5.04]). The AV was replaced in all cases. Mitral valve was repaired in 54 cases and replaced in 57. Concomitant procedures were performed in 44 cases. Median CPB and cross-clamp times were 198 [164-233] and 139 [117-160] minutes, respectively. In-hospital mortality was 3.6%, with low rates of stroke (3.6%), bleeding (8.1%), and dialysis (5.4%). At a median follow-up of 46 months, overall survival was 87%. Reduced estimated glomerular filtration rate (eGFR), coronary artery disease, chronic lung disease, and peripheral arteriopathy were significantly associated with the composite early outcome.

Endoscopic technique can be successfully applied to combined aortic and MV surgery, encouraging its broader adoption.

2020189, July 30, 2020.