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Outcomes Of Endoscopic Mitral Valve Repair In Asymptomatic Severe Mitral Regurgitation: A 19-year Single-centre Experience
Ghazi Elshafie, Joseph Zacharias.
Blackpool Victoria Hospital, Blackpool, United Kingdom.
Background:Early surgery for severe degenerative mitral regurgitation (MR) is recommended to avoid irreversible cardiac remodelling, including in asymptomatic patients. Evidence for totally endoscopic mitral valve repair (TEMVR) in this cohort is limited. We compared outcomes of asymptomatic (NYHA I) versus symptomatic (NYHA II-IV) patients undergoing TEMVR at a UK tertiary centre.
Methods:Retrospective analysis of consecutive patients with severe MR undergoing TEMVR (March 2006-February 2025). Patients were stratified by NYHA class. Demographics, operative details, morbidity, mortality, and long-term survival were evaluated. Statistical significance was set at p<0.05.
Results:808 patients underwent TEMVR: 136 NYHA I and 672 NYHA II-IV. Asymptomatic patients were younger (60.0 ± 12.7 vs 64.7 ± 13.5 years) with lower EuroSCORE II (1.62 ± 2.71 vs 2.83 ± 3.35; p<0.001). Tricuspid repair (11.8% vs 19.0%), AF ablation (16.2% vs 30.9%) and previous cardiac surgery (2.9% vs 6.3%) were more common in symptomatic patients. Complete ring annuloplasty rates were similar (49% vs 43%; p=0.26). ICU stay (1.15 ± 0.69 vs 1.27 ± 2.23 days; p=0.23) and postoperative AF (16.2% vs 13.7%; p=0.53) did not differ. Re-operation for bleeding was <3% in both groups. Hospital stay was shorter in NYHA I patients (6.2 ± 4.2 vs 7.4 ± 6.6 days; p=0.004). Operative mortality was low (0% vs 0.9%; p=0.58). Long-term survival was excellent in both cohorts.
Conclusion:TEMVR is safe in asymptomatic and symptomatic severe MR, with low morbidity, low mortality, and excellent long-term survival. Findings support early endoscopic repair in selected asymptomatic patients.
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