Minimally invasive mitral valve surgery: standard vs. endoscopic approach

Introduction Mitral valve surgery has evolved substantially, with a clear shift towards minimally invasive approaches. This study examines clinical outcomes associated with two established techniques: standard minimally invasive mitral valve surgery (ST) and the endoscopic (EMIC) approach. While benefits such as faster recovery, improved cosmetic outcomes, reduced postoperative pain, and less blood loss have been reported for both, direct comparative data between these two techniques remain limited. Methods We included 688 consecutive patients who underwent minimally invasive mitral valve surgery between 2018 and 2024 at our hospital. Amongst them, 514 patients (74,7%) were treated using the standard-MIC approach and 174 (25,3%) using the EMIC technique. Univariate analyses were performed to explore associations between surgical approach and relevant outcome parameters. Variables with a p -value < 0.05 were subsequently included in multivariate logistic regression analyses. Results In the EMIC group, longer operative times, extended extracorporeal circulation time [169 ± 47 min (EMIC) vs. 132 ± 39 min; p < 0.001] and aortic cross-clamp time (88 ± 25 min vs. 73 ± 23 min; p < 0.001) were observed. Postoperative renal replacement therapy [10.9% (EMIC) vs. 4.3% (ST); p = 0.003] and pericardial effusion [11.7% (EMIC) vs. 5.3% (ST); p = 0.008] occurred more frequently in the EMIC group. 30-day mortality was 2.9% (EMIC) vs. 1% (ST), p = n.s. No statistically significant difference was observed regarding other major outcome parameters. Discussion Minimally invasive mitral valve surgery can be safely performed using a standard minimally invasive or an endoscopic approach when performed by experienced surgeons. Despite longer operative times, the EMIC approach was feasible and demonstrated acceptable short-term safety within our institutional program, supporting its further clinical implementation.