Article Summary

Endoscopic ("key hole") Mitral Valve Repair

by The DiagnosisHeart.com Physician Team
Posted: February 26, 2003

Summary:
Aalst, Belgium - Investigators from the OLV Clinic, Moorselbaan have reported on a large series of patients who have undergone mitral valve repair using a totally endoscopic ("key hole") approach.

The study, published in the Journal of Thoracic and cardiovascular Surgery details the approach. Percutaneous techniques were used to place the pateint on cardiopulmonary bypass, with balloon catheters placed endovascularly to avoid clamping the aorta through a large chest incision.

Endoscopic instruments were used to repair the mitral valves in 187 patients by a single surgeon over the course of 4 years. No coronary bypass procedures were perfomred in conjunction with mitral valve repair.

Follow-up was complete in all patients and was for a period of 19 months, on average.

Only two patients required conversion from a "key hole" approach to open sternotomy in this series. One patient required reoperation early and 6 required late reoperation, the majority for endocarditis (infection of the valve). Other than that, repairs were successful using endoscopic instruments and successful in 93% of patients. That is, 93% of patients were "free from [need to have repeat] mitral valve operation" at 4 years of follow-up.

This series of patients from a single center, by a single surgeon demonstrates that in a carefully selected patient population, endoscopic mitral valve repair is feasible and safe with excellent outcomes in terms of freedom from reoperation at 4 years. Durability of repair was confirmed by transesophageal echocardiography intraoperatively. Of note, an overwhelming 98% of patients were pleased with the cosmetic results and 92% stated that they would choose to have the operation done the same way if he or she were faced the same operation again.

Endoscopic mitral valve repair is technically challenging and the authors of this study should be commended to have amassed a large study population. It is believed that as technology improves in the next 10 years, more and more mitral valve repairs can be routinely performed in this manner.

Reference:
Endoscopic Mitral Valve Repair: Feasible, Reproducible, and Durable, Journal of Thoracic and Cardiovascular Surgery 125: 273-282.

Date of Article Publication:
2003, February

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