Comparative outcomes of totally endoscopic versus direct vision mini-thoracotomy mitral valve repair: a propensity-matched retrospective analysis
File(s)
Published version (pre-proof)
Author(s)
Type
Journal Article
Abstract
Objectives
Totally endoscopic mitral valve repair has emerged as an alternative minimally invasive approach to direct vision mini-thoracotomy (DVMT) repair, using three-dimensional thoracoscopic guidance and a smaller working incision without rib-spreading. Whether these technical differences translate into improved outcomes remains uncertain.
Methods
A propensity-matched, retrospective analysis was conducted on 114 patients undergoing elective mitral valve repair for degenerative mitral regurgitation (MR) via totally endoscopic or DVMT approaches, across two UK tertiary centres (2015-2024). Patients were matched 1:1 on key pre-operative variables. The primary outcome was clinically significant recurrent MR on follow-up echocardiography. Secondary outcomes assessed operative parameters and recovery metrics. Multivariate regression identified predictors of relevant outcomes.
Results
Totally endoscopic repair was associated with lower odds of developing clinically significant recurrent MR (OR 0.05, 95% CI 0–0.32; p = 0.0094) compared with DVMT. Intra-operative metrics were broadly comparable, with the totally endoscopic procedure reporting marginal, non-significant increases in cardiopulmonary bypass and cross-clamp times. Immediate post-repair transoesophageal echocardiogram demonstrated no greater than mild residual MR in either cohort. Procedural safety was similar, with no 30-day mortality and low complication rates. Trends towards shorter intensive care and post-operative hospital stays were seen in totally endoscopic patients, though not statistically significant.
Conclusion
The totally endoscopic approach achieved more durable repairs, with comparable peri-operative safety to DVMT. The observed improvement in early repair durability remains hypothesis-generating and warrants further evaluation in larger studies with standardised long-term follow-up.
Mini-abstract
Totally endoscopic mitral valve repair was associated with lower odds of developing clinically significant recurrent mitral regurgitation, with comparable peri-operative safety to direct vision mini-thoracotomy. The observed improvement in early repair durability in this propensity-matched cohort remains hypothesis-generating and warrants further evaluation in larger studies with standardised long-term follow-up.
Totally endoscopic mitral valve repair has emerged as an alternative minimally invasive approach to direct vision mini-thoracotomy (DVMT) repair, using three-dimensional thoracoscopic guidance and a smaller working incision without rib-spreading. Whether these technical differences translate into improved outcomes remains uncertain.
Methods
A propensity-matched, retrospective analysis was conducted on 114 patients undergoing elective mitral valve repair for degenerative mitral regurgitation (MR) via totally endoscopic or DVMT approaches, across two UK tertiary centres (2015-2024). Patients were matched 1:1 on key pre-operative variables. The primary outcome was clinically significant recurrent MR on follow-up echocardiography. Secondary outcomes assessed operative parameters and recovery metrics. Multivariate regression identified predictors of relevant outcomes.
Results
Totally endoscopic repair was associated with lower odds of developing clinically significant recurrent MR (OR 0.05, 95% CI 0–0.32; p = 0.0094) compared with DVMT. Intra-operative metrics were broadly comparable, with the totally endoscopic procedure reporting marginal, non-significant increases in cardiopulmonary bypass and cross-clamp times. Immediate post-repair transoesophageal echocardiogram demonstrated no greater than mild residual MR in either cohort. Procedural safety was similar, with no 30-day mortality and low complication rates. Trends towards shorter intensive care and post-operative hospital stays were seen in totally endoscopic patients, though not statistically significant.
Conclusion
The totally endoscopic approach achieved more durable repairs, with comparable peri-operative safety to DVMT. The observed improvement in early repair durability remains hypothesis-generating and warrants further evaluation in larger studies with standardised long-term follow-up.
Mini-abstract
Totally endoscopic mitral valve repair was associated with lower odds of developing clinically significant recurrent mitral regurgitation, with comparable peri-operative safety to direct vision mini-thoracotomy. The observed improvement in early repair durability in this propensity-matched cohort remains hypothesis-generating and warrants further evaluation in larger studies with standardised long-term follow-up.
Date Issued
2026-06-23
Date Acceptance
2026-05-29
Citation
JTCVS Open, 2026
ISSN
2666-2736
Publisher
Elsevier BV
Journal / Book Title
JTCVS Open
Copyright Statement
© 2026 The Authors. Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
Publication Status
Published online
Article Number
101939
Date Publish Online
2026-06-23