title: Mitral valve surgery can now routinely be performed endoscopically.
abstract: BACKGROUND
  There is an increasing interest in minimally invasive cardiac surgery.
  
  
  RESULTS
  Since February 1, 1997 till April 1, 2002, 306 patients underwent endoscopic mitral valve surgery (226 repair, MVP; 80 replacement, MVR). Predominant valve pathology was degenerative in MVP (83.6%) and rheumatic in MVR (65%). Mean age was 61.5+/-12.9 years. Median preoperative functional class (MVP+MVR) and mitral regurgitation (MVP) were II and 4+. Statistical analysis included Kaplan-Meier and Cox regression methods. Mean follow-up was 19.6+/-17.3 months and complete. The procedure was successfully performed in all but 6 patients. Hospital mortality included 3 patients (1%) and was technology related in one. Postoperative morbidity included aggressive re-exploration (8.5%), new onset atrial fibrillation (17.0%), and pacemaker implantation (2.3%). There were 1 early and 10 late reoperations, 5 of which were because of endocarditis. Freedom from mitral valve reoperation at 4 years was 91+/-3.5%. No risk factors for reoperation could be detected. Echocardiographic follow-up showed a median degree of mitral regurgitation (MVP) of 0 and a small paravalvular leak in four patients (MVR). Ninety-four percent of the patients reported no or mild postoperative pain and 99.3% felt they had an esthetically pleasing scar. Ninety-three percent would choose the same procedure again and 46.1% were back at work within 4 weeks.
  
  
  CONCLUSIONS
  Endoscopic mitral valve surgery can be performed safely but definitely requires a learning curve. Good results and a high patient satisfaction are guaranteed. It is now our exclusive approach for isolated atrioventricular valve disease.
authors.affiliation: Department of Cardiovascular and Thoracic Surgery, OLV Clinic, Moorselbaan 164, 9300 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: Francis
authors.initials: F
authors.lastname: Wellens
authors.forename: Raphael
authors.initials: R
authors.lastname: De Geest
authors.forename: Ivan
authors.initials: I
authors.lastname: Degrieck
authors.forename: Frank
authors.initials: F
authors.lastname: Van Praet
authors.forename: Yvette
authors.initials: Y
authors.lastname: Vermeulen
authors.forename: Hugo
authors.initials: H
authors.lastname: Vanermen
mesh_terms: D004452:Echocardiography; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D017060:Patient Satisfaction; D011184:Postoperative Period; D012086:Reoperation; D016896:Treatment Outcome