Comparison of Endoscopic vs. Open Mitral and Concomitant Tricuspid Valve Repair

All articles of this category (opens in new window) Background: Over the past two decades, interest in and adoption of minimally invasive mitral valve surgery (MIS) have grown significantly. Despite this increase, MIS techniques remain notably underrepresented and have only recently been introduced into contemporary valvular heart disease guidelines. Therefore, further evidence-based studies are needed to prove their superiority over conventional approaches, particularly in cases involving concomitant procedures. Methods: A retrospective, single-center analysis of 655 patients receiving mitral valve repair between 2015 and 2025 was performed. Within this cohort, a subgroup of 101 patients underwent concomitant tricuspid valve repair (MIS = 15; FS = 86), presenting with largely balanced preoperative risk profiles and baseline characteristics. Results: Intraoperative data revealed that the MIS group had significantly longer overall operation duration (258 ± 42 vs. 215 ± 45 minutes), cardiopulmonary bypass time (178 ± 59 vs. 130 ± 28 minutes), and cross-clamp time (98 ± 36 vs. 83 ± 17 minutes; all p < 0.05). However, postoperative ventilation duration (6 ± 3 vs. 11 ± 8 hours) and intensive care unit-stay (3 ± 3 vs. 5 ± 5 days) were significantly shorter in the MIS group. Rates of postoperative in-hospital complications—including ischemic stroke (0.0% vs. 3.5%), major bleeding (0.0% vs. 1.4%), new pacemaker implantation due to atrioventricular block (6.7% vs. 11.6%), myocardial infarction (0.0% in both groups), endocarditis (0.0% in both groups), and deep wound infection (0.0% vs. 2.3%)—did not differ significantly between MIS and FS ( p > 0.05). Thirty-day all-cause mortality was also similar (0.0% vs. 2.3%, p > 0.05). Conclusion: MIS with concomitant TVR is a safe alternative to conventional surgery for combined atrioventricular valve repair. In experienced centers, it should be considered the standard of care whenever possible to avoid full sternotomy. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany