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Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Totally endoscopic mitral valve replacement: reasons for non-feasibility of repair and 5-year outcomes

  • Friedrich Sobik1
  • Jonas Pausch1
  • Xiaoqin Hua2
  • Martin Beyer1,3
  • Evelina Macius1
  • Oliver Bhadra1
  • Yousuf Alassar1
  • Benjamin Kloth1
  • Lenard Conradi2
  • Hermann Reichenspurner1
  • Simon Pecha1
  • Evaldas Girdauskas1
1 more authors
  • Andreas Schaefer1
  1. 1Department of Cardiac Surgery, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf
  2. 2Department of Cardiac Surgery, University Hospital Cologne
  3. 3DZHK (German Centre for Cardiovascular Research), Partner Site North
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Abstract

Objectives: Totally endoscopic mitral valve (MV) surgery is an established therapy for mitral regurgitation (MR) with high repair rates at experienced centers. In certain scenarios, however, repair is not feasible, necessitating chordal-sparing MV replacement. This study investigates the reasons for totally endoscopic MV replacement and reports 5-year outcomes.

Methods: Between 2012 and 2022, 1,037 consecutive patients underwent totally endoscopic MV surgery. Of those, 75 patients (7.2%) underwent chordal-sparing MV replacement. Preoperative characteristics, periprocedural data, and mid-term outcomes were retrospectively analyzed and compared to a 1:1 propensity score-matched repair group.

Results: After matching, baseline characteristics were balanced. Indications for MV replacement included sclerotic leaflets (28.0%), endocarditis (26.7%), MV stenosis (17.3%), failed repair attempt (17.3%), rheumatic disease (12.0%), and residual MR after transcatheter edge-to-edge repair (7%). Cross-clamp and bypass times were similar. Re-thoracotomy occurred in 14.7% vs. 6.7%, while permanent pacemaker implantation occurred solely after replacement (16.0%). Low cardiac output rates were comparable (6.7% vs. 5.5%). Transvalvular gradients at discharge were higher after replacement ( p < 0.001). No paravalvular leakage was observed. In-hospital mortality was 4% vs. 0%. Five-year survival was 86.7% vs. 94.7%, and reintervention rates were similar (4.0% vs. 6.7%).

Conclusion: Totally endoscopic MV surgery at a high-volume center is infrequently associated with MV replacement. The main reasons included sclerotic leaflet pathology, MV stenosis, and endocarditis. Despite a higher comorbidity burden and residual baseline imbalance after matching, early and mid-term outcomes were acceptable. Totally endoscopic chordal-sparing MV replacement represents a safe and clinically effective treatment option for selected patients.

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Cite

BibTeXRIS
BibTeX
@article{sobik2026totally,
  title = {{Totally endoscopic mitral valve replacement: reasons for non-feasibility of repair and 5-year outcomes}},
  author = {Friedrich Sobik and Jonas Pausch and Xiaoqin Hua and Martin Beyer and Evelina Macius and Oliver Bhadra and Yousuf Alassar and Benjamin Kloth and Lenard Conradi and Hermann Reichenspurner and Simon Pecha and Evaldas Girdauskas and Andreas Schaefer},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = oct,
  doi = {10.3389/fcvm.2026.1903773},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1903773/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Totally endoscopic mitral valve replacement: reasons for non-feasibility of repair and 5-year outcomes
AU  - Friedrich Sobik
AU  - Jonas Pausch
AU  - Xiaoqin Hua
AU  - Martin Beyer
AU  - Evelina Macius
AU  - Oliver Bhadra
AU  - Yousuf Alassar
AU  - Benjamin Kloth
AU  - Lenard Conradi
AU  - Hermann Reichenspurner
AU  - Simon Pecha
AU  - Evaldas Girdauskas
AU  - Andreas Schaefer
PY  - 2026
DA  - 2026/10/20
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1903773
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1903773/full
AB  - Objectives: Totally endoscopic mitral valve (MV) surgery is an established therapy for mitral regurgitation (MR) with high repair rates at experienced centers. In certain scenarios, however, repair is not feasible, necessitating chordal-sparing MV replacement. This study investigates the reasons for totally endoscopic MV replacement and reports 5-year outcomes.  Methods: Between 2012 and 2022, 1,037 consecutive patients underwent totally endoscopic MV surgery. Of those, 75 patients (7.2%) underwent chordal-sparing MV replacement. Preoperative characteristics, periprocedural data, and mid-term outcomes were retrospectively analyzed and compared to a 1:1 propensity score-matched repair group.  Results: After matching, baseline characteristics were balanced. Indications for MV replacement included sclerotic leaflets (28.0%), endocarditis (26.7%), MV stenosis (17.3%), failed repair attempt (17.3%), rheumatic disease (12.0%), and residual MR after transcatheter edge-to-edge repair (7%). Cross-clamp and bypass times were similar. Re-thoracotomy occurred in 14.7% vs. 6.7%, while permanent pacemaker implantation occurred solely after replacement (16.0%). Low cardiac output rates were comparable (6.7% vs. 5.5%). Transvalvular gradients at discharge were higher after replacement ( p < 0.001). No paravalvular leakage was observed. In-hospital mortality was 4% vs. 0%. Five-year survival was 86.7% vs. 94.7%, and reintervention rates were similar (4.0% vs. 6.7%).  Conclusion: Totally endoscopic MV surgery at a high-volume center is infrequently associated with MV replacement. The main reasons included sclerotic leaflet pathology, MV stenosis, and endocarditis. Despite a higher comorbidity burden and residual baseline imbalance after matching, early and mid-term outcomes were acceptable. Totally endoscopic chordal-sparing MV replacement represents a safe and clinically effective treatment option for selected patients.
SN  - 2297-055X
ER  -