Evolution of endoscopic mitral valve surgery over a 11-year period at a high-volume center

Endoscopic mitral valve surgery (MVS) has evolved at specialized centers aiming to reduce surgical trauma and improve recovery. The aim of this study was to monitor the evolution and temporal changes of endoscopic MVS at our institution.

Between 2012 and 2022, a total of 1.037 consecutive patients underwent endoscopic MVS and were categorized into an initial- (2012-2017; n = 487) and a late-group (2018-2022; n = 550). Data was retrospectively analyzed.

Patient age increased during the study period from 56.0 (47.0-64.2) to 61.0 (55.0-68.0) years (p trend = 0.0275). The prevalence of coronary artery disease (9.3% vs 17.1%; P < .001) and endocarditis (2.1% vs 6.0%; P = .0026) differed between groups. Median STS PROM score increased from 0.3 (0.3-0.5) to 0.4 (0.3-0.9) (p trend < 0.001). MV repair was performed in 92.7%. Concomitant procedures, eg, closure of left atrial appendage (21.0%), atrial ablation (19.2%) or tricuspid valve repair (6.7%) increased significantly over time (p trend < 0.01). Nevertheless, median bypass and cross-clamp times decreased (p trend < 0.001). Median postoperative ventilation time was 5.0 (3.3-7.0) hours and decreased during the study-period (p trend < 0.001). Length of intensive care unit and in-hospital stay were 2.0 (1.0-3.0) and 7.0 (6.0-9.0)days, respectively. At 30 days, overall mortality was 0.6% excluding patients with endocarditis. After 5 years re-operation rate was 2.5% and overall survival was 94.0%. During a maximum follow up of 11.2 years, reoperation rate was 5.0%, whereas overall survival was 88.5%.

In the present analysis, evolution of endoscopic MVS from isolated procedures in young, low-risk patients with simple MV pathology to combined procedures in older patients with complex MV disease, was demonstrated. Despite increasing surgical risk, complexity of MV disease as well as an increasing rate of concomitant procedures, perioperative outcome remained favorable over time, resulting in promising mid- to long-term results.