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(Circulation. 2003;108:II-48.)
© 2003 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Mitral Valve Surgery Can Now Routinely Be Performed Endoscopically

Filip P. Casselman, MD, PhD, FETCS; Sam Van Slycke, MD; Francis Wellens, MD, FETCS; Raphael De Geest, MD; Ivan Degrieck, MD, FETCS; Frank Van Praet, MD, FETCS; Yvette Vermeulen, MSc; Hugo Vanermen, MD, FETCS

From the Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium.

Correspondence to Filip P. Casselman, MD, PhD, FETCS, Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Moorselbaan 164, 9300 Aalst, Belgium. Phone: 32-53-724599; Fax: 32-53-724552; E-mail: Filip.Casselman{at}olvz-aalst.be

Background— There is an increasing interest in minimally invasive cardiac surgery.

Methods and Results— Since February 1, 1997 till April 1, 2002, 306 patients underwent endoscopic mitral valve surgery (226 repair, MVP; 80 replacement, MVR). Predominant valve pathology was degenerative in MVP (83.6%) and rheumatic in MVR (65%). Mean age was 61.5±12.9 years. Median preoperative functional class (MVP+MVR) and mitral regurgitation (MVP) were II and 4+. Statistical analysis included Kaplan-Meier and Cox regression methods. Mean follow-up was 19.6±17.3 months and complete. The procedure was successfully performed in all but 6 patients. Hospital mortality included 3 patients (1%) and was technology related in one. Postoperative morbidity included aggressive re-exploration (8.5%), new onset atrial fibrillation (17.0%), and pacemaker implantation (2.3%). There were 1 early and 10 late reoperations, 5 of which were because of endocarditis. Freedom from mitral valve reoperation at 4 years was 91±3.5%. No risk factors for reoperation could be detected. Echocardiographic follow-up showed a median degree of mitral regurgitation (MVP) of 0 and a small paravalvular leak in four patients (MVR). Ninety-four percent of the patients reported no or mild postoperative pain and 99.3% felt they had an esthetically pleasing scar. Ninety-three percent would choose the same procedure again and 46.1% were back at work within 4 weeks.

Conclusions— Endoscopic mitral valve surgery can be performed safely but definitely requires a learning curve. Good results and a high patient satisfaction are guaranteed. It is now our exclusive approach for isolated atrioventricular valve disease.

Key Words: Key-words: • mitral valve • endoscopic • surgery • minimally invasive