What is the clinical evidence from this study?

Study design: Cohort. Population: Mitral valve disease requiring plasty (n=125). Intervention: Totally endoscopic mitral valve plasty (complex cases) vs. Totally endoscopic mitral valve plasty (non-complex cases). Primary outcome: Complication rates (p=0.012).

What does this research mean for the field?

Totally endoscopic mitral valve plasty (TEMVP) demonstrates a manageable learning curve and maintains acceptable safety limits during the initial adoption phase, even when including complex cases. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

This study aims to evaluate the learning curve and outcomes of totally endoscopic mitral valve plasty during the initial adoption phase.

June 1, 2026

Safety and Learning Curve of Totally Endoscopic Mitral Valve Plasty: Initial 125 Cases Evaluated by Operative Time and RA-CUSUM Method

Key Result

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.

Key Points

This study aims to evaluate the learning curve and outcomes of totally endoscopic mitral valve plasty during the initial adoption phase.
Retrospective analysis of 125 consecutive patients undergoing TEMVP from October 2021 to April 2025.
Comparison of surgical outcomes between a complex group (40 patients) and a control group (85 patients).
Learning curve assessed using operation time and RA-CUSUM analysis based on predicted morbidity scores.
Complex group had longer operative times (335 ± 71 min vs 282 ± 61 min, P < 0.001) and higher complication rates (17.5% vs 3.5%, P = 0.012).
Two-year survival rates were 94.7% in the complex group and 100% in the control group (P = 0.03).
Overall operation time decreased over time, with RA-CUSUM showing favorable cumulative trends for safety.

Study Design

Type

Cohort (n=125)

Multicenter

Structured PICO

Does totally endoscopic mitral valve plasty (TEMVP) have a safe learning curve and acceptable perioperative outcomes in complex versus non-complex patients?

Population

125 consecutive patients who underwent totally endoscopic mitral valve plasty (TEMVP), including 40 patients with complex pathology (concomitant procedures, infective endocarditis, reoperation, narrow thoracic cage, or difficult aortic cross-clamping) and 85 control patients.

Intervention

Totally endoscopic mitral valve plasty (TEMVP) in patients with complex pathology

Comparator

Totally endoscopic mitral valve plasty (TEMVP) in non-complex patients (control group)

Outcome

Learning curve and perioperative outcomes evaluated by operation time and complications (assessed via RA-CUSUM analysis based on predicted morbidity)safety

Early adoption of totally endoscopic mitral valve plasty demonstrates a manageable learning curve and acceptable safety profile, even when including complex cases.

Main Result

Absolute Event Rate: 17.5% vs 3.5%

p-value: p=0.012

Abstract

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.

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