Endoscopic Mitral Valve Surgery for Infective Endocarditis: A Single Center Experience

All articles of this category (opens in new window) Background: Endoscopic mitral valve surgery (MVS) is a safe alternative to median sternotomy, aiming at improved recovery and reduced perioperative complications for the treatment of mitral valve (MV) disease. However, the safety of endoscopic M vs. for acute MV infective endocarditis (IE) remains to be investigated. Methods: Between January 2012 and January 2024, a total of 1,157 consecutive patients underwent fully endoscopic M vs. at our institution. Of those, 41 patients (3.5%) suffered from acute MV IE. All patients received endoscopic M vs. via right-sided anterolateral or transaxillary skin incision and 3D-camera visualization. Preoperative characteristics, periprocedural data, and mid-term outcome were retrospectively analyzed. Results: Median age was 63 (55–70) years, 51.2% were male, and the median STS PROM Score was 0.97 (0.47–2.07). Increased body temperature was present in 35.7% of patients, and 21.9% suffered from acute stroke. In 33 patients (80.5%), mitral regurgitation (MR) was severe, and 6 patients suffered from moderate MR (14.6%). The rate of MV repair was 41.5% and 58.5% of patients underwent MV replacement. Repair techniques included MV annuloplasty ( n = 15), chordal replacement ( n = 10), and leaflet resection ( n = 7). Median cross-clamp and cardiopulmonary bypass times were 85 (71–98) and 137 (121–158) minutes. Postoperatively, 8 patients (19.5%) underwent re-thoracotomy for bleeding. Three patients underwent permanent pacemaker implantation. No perioperative stroke was documented. Two patients (4.9%) suffered from low cardiac output syndrome (LCOS) in terms of a prolonged need for catecholamines. Patients were extubated after a median postoperative ventilation time of 3.0 (2.0–5.7) hours and released from the intensive care unit after a median stay of 2 (1–3.5) days. Median length of in-hospital stay was 10 (7–13) days. In-hospital mortality rate was 2.4% ( n = 1). A total of two patients underwent MV re-operation after a median of 20 (19.5–20.5) months after the index procedure due to recurrent MV IE. During a median follow-up of 48 (30–84) months, overall survival was 85.4%. Conclusion: Endoscopic M vs. for MV IE is rarely performed, suggesting preoperative selection of suitable patients regarding the extent of cardiac infection and clinical status. This assumption is supported by the herein presented high repair rates. However, the investigated cohort showed low mortality and perioperative complication rates, suggesting that endoscopic M vs. is a valuable therapeutic option for selected MV IE patients. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany