Totally endoscopic mitral valve plasty in complex cases resulted in higher complication rates (17.5% vs 3.5%, P=0.012) and longer operative times compared to non-complex cases.
Cohort (n=125)
No
Does totally endoscopic mitral valve plasty (TEMVP) have a safe learning curve and acceptable perioperative outcomes in complex versus non-complex patients?
Early adoption of totally endoscopic mitral valve plasty demonstrates a manageable learning curve and acceptable safety profile, even when including complex cases.
Tasa de eventos absoluta: 17.5% vs 3.5%
valor p: p=0.012
Objective: Totally endoscopic mitral valve plasty (TEMVP) requires technical proficiency, which may be insufficient during the initial adoption phase. This study evaluated the learning curve and perioperative outcomes during the early experience with TEMVP, using operation time and complications as key metrics. Methods: We retrospectively analyzed 125 consecutive patients who underwent TEMVP between October 2021 and April 2025. Despite the early adoption phase, 40 patients met criteria for complex pathology (i.e., concomitant procedures, infective endocarditis, reoperation, narrow thoracic cage, or difficult aortic cross-clamping) and were defined as the complex group. The remaining 85 patients formed the control group. Surgical outcomes were compared between groups. The learning curve was assessed using operation time and risk-adjusted cumulative sum (RA-CUSUM) analysis based on predicted morbidity (Japan Score). Results: The complex group had longer operative times (335 ± 71 vs 282 ± 61 min, P < 0.001) and higher complication rates (17.5% vs 3.5%, P = 0.012). Two-year survival was 94.7% in the complex group and 100% in the control group ( P = 0.03); freedom from reoperation was 100% and 94.2%, respectively ( P = 0.30). Operation time significantly decreased over time in the overall and control groups but not in the complex group. RA-CUSUM analysis showed favorable cumulative trends below the predicted risk threshold, with no group exceeding the sequential probability ratio test decision limit of ±3.74. Conclusions: Despite the inclusion of complex cases, early TEMVP outcomes were favorable and within acceptable safety limits. RA-CUSUM and operation time analysis supported the presence of a manageable learning curve at our institution.
Nakai et al. (Sat,) conducted a cohort in Mitral valve disease requiring plasty (n=125). Totally endoscopic mitral valve plasty (complex cases) vs. Totally endoscopic mitral valve plasty (non-complex cases) was evaluated on Complication rates (p=0.012). Totally endoscopic mitral valve plasty in complex cases resulted in higher complication rates (17.5% vs 3.5%, P=0.012) and longer operative times compared to non-complex cases.