NO PATIENT SELECTION IN TOTALLY ENDOSCOPIC ISOLATED MITRALVALVE SURGERY: OPERATIVE AND EARLY RESULTS IN DEGENERATIVE MITRAL VALVE REGURGITATION

Background and aim In high–volume centers MICS can be offered to any patient affected by degenerative mitral valve surgery (MVS). Aim of this study was to evaluate early outcomes in patients undergoing isolated MVS for degenerative mitral regurgitation (MR) using a totally endoscopic technique. Methods From January 2018 to December 2022, 1124 consecutive unselected patients underwent endoscopic MVS at our institution. Among them, 399 patients underwent isolated MVS for degenerative valve pathology. Concomitant surgery and different etiology were excluded. All patients were approached with peripheral cannulation, limited skin incision (peri–areolar/sub–mammary/anterior axillary line) and 5 mm 30° endoscope. Neo–chordae implantation plus annuloplasty ring was the preferred technique for mitral repair. Results Endoscopic MVS was achieved in all patients and no conversion to sternotomy was needed. Median Cross–Clamp and CPB Time were respectively 93 [75 – 11] and 143 minutes [115 – 171]. Overall in hospital mortality was 0.75%. Major Stroke occurred in 1.6%. Replacement for unsuccessful repair occurred in 4 patients (1%). Repeated cross–clamp for residual MR in 13 patients (3,3%). Median intubation time was 5 h [3 – 7], ICU time was 18 h [15 – 21], bleeding requiring revision occurred in 21 patients (5.3%) always through the same access. PM implantation occurred in 3%, vascular complications in 1%. We had 1 case of endocarditis, 1 case of early failure, 1.3% mitral redo. Conclusions In high volume centers isolated endoscopic MVS without preoperative patient selection has proven to be safe with optimal mortality, good fast–track and low incidence of complications.