title: Endoscopic mitral valve repair: feasible, reproducible, and durable.
abstract: OBJECTIVE
  We sought to document the feasibility, safety, and effectiveness of performing mitral valve repair using a totally endoscopic approach.
  
  
  METHODS
  Between February 1997 and October 1, 2001, 187 patients underwent totally endoscopic mitral valve repair at our institution. The mean age was 60.7 +/- 13.1 years, and 62% were male. Median preoperative functional class and degree of mitral regurgitation were II and 4, respectively. Data collection included an institutional protocol assessing procedure-related pain, cosmesis, and functional recovery. Statistical analysis included Kaplan-Meier and Cox regression methods. Mean follow-up was 19 +/- 15.2 months and was 100% complete.
  
  
  RESULTS
  Associated atrial procedures were performed in 9.1% (n = 17) of the patients. Two patients required intraoperative conversion to sternotomy. Thoracoscopic re-evaluation for suspected bleeding (n = 19) was part of our aggressive postoperative management. One patient required sternotomy for control of bleeding. Hospital mortality included 1 (0.5%) patient and was not technology related. There were 1 early and 6 late reoperations, 4 of which were due to endocarditis. No risk factors for repair failure could be detected. Freedom from mitral valve reoperation at 4 years was 93.3% +/- 2.6%. The median degree of mitral regurgitation at follow-up was 0. Ninety-three percent of the patients were highly satisfied with either no or mild postoperative pain, and 98.4% believed they had an aesthetically pleasing scar.
  
  
  CONCLUSIONS
  Totally endoscopic mitral valve repair can be done safely with excellent results and a high degree of patient satisfaction. It is now our exclusive approach for isolated atrioventricular valve disease.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Aalst, Belgium. Filip.Casselman@olvz-aalst.be
authors.forename: Filip P
authors.initials: FP
authors.lastname: Casselman
authors.forename: Sam
authors.initials: S
authors.lastname: Van Slycke
authors.forename: Helge
authors.initials: H
authors.lastname: Dom
authors.forename: Dave L
authors.initials: DL
authors.lastname: Lambrechts
authors.forename: Yvette
authors.initials: Y
authors.lastname: Vermeulen
authors.forename: Hugo
authors.initials: H
authors.lastname: Vanermen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D015505:Chest Tubes; D004954:Esthetics; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000145:classification / Q000401:mortality / Q000523:psychology / Q000601:surgery*; D010149:Postoperative Pain / Q000209:etiology; D017060:Patient Satisfaction; D016016:Proportional Hazards Models; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D012449:Safety; D012720:Severity of Illness Index; D016019:Survival Analysis; D013906:Thoracoscopy / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome