International Society For Minimally Invasive Cardiothoracic Surgery

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Total Endoscopic Mitral Valve Surgery For Endocarditis
Daniel Hoefer, Herbert Hangler, Christoph Krapf, Nikos Bonaros, Johannes Holfeld, Cenk Özpeker, Michael Grimm, Ludwig Mueller.
Cardiac Surgery Innsbruck, Innsbruck, Austria.

Background: To evaluate feasibility, safety and outcomes of total endoscopic mitral valve (MV) surgery in patients with MV endocarditis.Methods: Between 2015 and 2018 a total number of 237 minimal invasive mitral valve procedures were performed. In 17 cases (7.2%) the indication was MV endocarditis (5 acute and 12 sub-acute procedures). Surgery was performed totally endoscopic with the use of a 3D endoscope via lateral micro incision.Results: Mean age was 61 years, 9 (53%) were male, 8 (47%) female. Both MV leaflets were affected in 8 (43%) cases, in all patients MV repair was successfully accomplished. Repair techniques included resection, pericardial patch plasty, sliding leaflet plasty and neochordae. Ablation for atrial fibrillation (n=1) and tricuspid valve repair (n=1) were concomitant procedures. Mean bypass time was 204 minutes, mean aortic cross clamp time was 118 minutes. Conversion to sternotomy was required in 1 (5.9%) patient, in 2 (11.8%) patients revision for bleeding was necessary. Due to pulmonary edema 2 (11.8%) patients were successfully treated with ECMO. All patients were discharged home alive with excellent repair results (82% grade 0 MV insufficiency). Three patients (18%) required reoperation due to recurrent endocarditis.Conclusions: Patients presenting with MV endocarditis require complex MV repair under complicated circumstances. Endoscopic procedure might reduce trauma and facilitate success of MV repair. Our series demonstrate feasibility and safety of total endoscopic MV surgery due to endocarditis with no mortality and excellent repair results.

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