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Minimally invasive mitral valve surgery: standard vs. endoscopic approach
Georgios Theodosiadis1, Afsaneh Karimian-Tabrizi1, Tomas Holubec1
1Department of Cardiac and Vascular Surgery, University Hospital Frankfurt and Goethe University Frankfurt, Frankfurt am Main, Germany.
Frontiers in Cardiovascular Medicine
|March 9, 2026
Summary
Endoscopic minimally invasive mitral valve surgery (EMIC) shows acceptable short-term safety despite longer operative times. Experienced surgeons can safely perform both standard minimally invasive mitral valve surgery and EMIC, supporting EMIC
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Techniques
- Surgical Outcomes
Background:
- Minimally invasive mitral valve surgery (MIMVS) is increasingly preferred over traditional open-heart procedures.
- Standard minimally invasive (ST) and endoscopic (EMIC) approaches are established MIMVS techniques.
- Comparative outcome data between ST and EMIC are limited.
Purpose of the Study:
- To compare clinical outcomes between standard minimally invasive mitral valve surgery (ST) and endoscopic minimally invasive mitral valve surgery (EMIC).
Main Methods:
- Retrospective analysis of 688 patients undergoing MIMVS between 2018-2024.
- Patients were divided into ST (n=514) and EMIC (n=174) groups.
- Univariate and multivariate logistic regression analyses were used to compare outcomes.
Main Results:
- EMIC group experienced longer operative times, extracorporeal circulation, and aortic cross-clamp times (p < 0.001).
- Higher rates of postoperative renal replacement therapy (10.9% vs 4.3%, p = 0.003) and pericardial effusion (11.7% vs 5.3%, p = 0.008) were observed in the EMIC group.
- No significant difference in 30-day mortality or other major outcomes was found.
Conclusions:
- Both ST and EMIC approaches are safe when performed by experienced surgeons.
- EMIC is feasible with acceptable short-term safety, despite longer operative times.
- Findings support the further clinical implementation of the EMIC approach.
Keywords:
endoscopic approachminimally invasive mitral valve repairminimally invasive mitral valve surgerymitral valve repairmitral valve surgeryMore Related Videos
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