Objective: The aim was to assess the long-term outcomes, safety, and durability of total endoscopic mitral valve repair for Barlow mitral valve disease. Methods: A retrospective analysis of 98 patients undergoing minimal invasive total endoscopic mitral valve repair for Barlow mitral valve disease was conducted between May 2009 and December 2023. A non-resectional repair approach using artificial neochordae and/or ring annuloplasty was performed. Clinical and echocardiographic follow-ups were completed. Rates per patient-years with 95% confidence intervals (CI) for all time-to-event outcomes were calculated. Results: The mean age was 59 ± 12, and 43% were female. Minimally invasive mitral valve repair was successfully performed in all 98 patients with no conversions to sternotomy or mitral valve replacement. There was no mitral valve-related reoperation during the hospital stay. Procedural safety was as follows: no in-hospital mortality, no stroke, and no perioperative myocardial infarction. The mean follow-up was 4.1 ± 3.1 years. Survival at seven years was 87% (95% CI 63% to 96%). Freedom from myocardial infarction, stroke, and congestive heart failure was 89% (95% CI 60% to 97%), 93% (95% CI 82% to 97%), and 100%, respectively. Recurrent mitral valve insufficiency at Grade ≥ 2 was diagnosed in n = 4 (4.1%) of cases. Conclusions: Minimally invasive mitral valve repair using a non-resectional technique for Barlow disease can be performed with a low complication rate. The total endoscopic approach is safe in the long term, with minimal risk of reoperation and recurrent mitral valve insufficiency.

Objectives: To assess mid-term outcomes in patients with early silent coronary bypass occlusion. Methods: 292 consecutive patients who underwent isolated coronary artery bypass grafting (CABG) between July 2021 and December 2023 were included in this prospective cohort study. Silent CABG occlusion was defined as a bypass occlusion detected by coronary CT before discharge and without clinical suspicion of perioperative myocardial infarction. The primary endpoint was the incidence of angina-related rehospitalisation and coronary revascularisation during the follow-up. The secondary endpoint was the incidence of major adverse cardiovascular and cerebrovascular events, defined as a composite of all-cause mortality, myocardial infarction and stroke. Results: The mean age was 67±9.5 years, with 85.3% (n=249) being male. Early silent occlusion was identified in 25 patients (8.5%). The median hospital stay was longer in the occlusion group with 10 days (IQR 8.0–12.0), versus 8.0 days (IQR 7.0–9.0) in the non-occlusion group (p<0.001). The median follow-up duration was 14.5 (IQR 13.3–16.5) months. The incidence of angina-related rehospitalisation and revascularisation was significantly higher in patients with graft occlusion (p<0.01). Cox proportional hazards regression identified graft occlusion as a strong predictor of rehospitalisation (HR=8.55, 95% CI: 3.23 to 22.64; p<0.001) and reintervention (HR=15.12, 95% CI: 4.89 to 46.74; p<0.001), indicating nearly a 9-fold higher risk of rehospitalisation and a 15-fold increased hazard of reintervention. Conclusion: In-hospital silent graft occlusion following CABG is associated with a higher incidence of angina-related rehospitalisation and revascularisation during mid-term follow-up. Trial registration number: NCT04595630 .