Minimally invasive endoscopic mitral valve repair-the new gold standard for degenerative mitral valve disease.

Abstract

Almost 2 decades ago, the first successful case series demonstrated feasibility and safety of minimally invasive access mitral valve surgery (MIMVS) [1]. Subsequently, larger series reported longer-term follow-up with durable repair results for degenerative mitral valve pathologies with freedom from recurrent mitral regurgitation of at least 92% at 5 years [2]. Despite these convincing data, minimally invasive access for mitral valve repair is still under debate within the cardiac surgical community and not standard of care in all healthcare systems. In this issue of the European Journal of Cardiothoracic Surgery, Bonaros et al. [3] share their experience with a well-established MIMVS programme. The reported safety and functional outcome data are impressively good. Even more interesting are the surgical details discussed and the procedural changes in their practice over an almost 20-year time span including the addition of routine preoperative Computed tomography scans (CT) scans, the adoption of a non-rib-spreading 3D endoscopic approach and the trend from resection techniques towards leaflet preserving repair techniques including the use of artificial chordae.