Moving from minimally invasive to totally endoscopic mitral valve surgery: a retrospective review of outcomes

OBJECTIVES: Mitral valve surgery has undergone significant advancements with the emergence of minimally invasive mitral surgery harnessing endoscopic technology to facilitate repair through a right anterior thoracotomy. Further refinement within the field has borne the novel totally endoscopic approach, reducing incision size, and surgical trauma, to 3 cm. While there is evidence to support non-inferiority of minimally invasive techniques compared to a traditional sternotomy, a knowledge gap exists regarding the comparative safety and efficacy between minimally invasive modalities, necessitating. METHODS: A retrospective review of outcomes following totally endoscopic and minimally invasive mitral valve surgery by right anterior thoracotomy was completed. One hundred eighty-six patients were included, all operations having been performed by a single surgeon, between January 2019 and June 2023. The hypothesis posits that the former offers an equivalence in repair while reducing postoperative pain, bleeding from the wound and enhancing cosmesis. RESULTS: While low 30-day mortality rates were seen in both cohorts, the totally endoscopic group exhibited lower rates of patients discharged with opiates (16% vs 23%), reduced blood product transfusion requirements (33% vs 43%) and shorter postoperative stays (mean of 9.2 days vs 11.4 days). CONCLUSIONS: Moving from minimally invasive to totally endoscopic mitral valve surgery has been a positive experience with key patient advantages characterized by smaller incisions and avoidance of rib spreading. In this dataset, improved patient outcomes such as postoperative bleeding, pain, length of hospital stay and cosmesis were observed with all limitations given its fully uncontrolled nature. Validation of these findings warrants a larger study.