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Endoscopic mitral valve repair or replacement, without opening the sternum.

A 4–5 cm right-side incision, a 3D endoscope, peripheral cardiopulmonary bypass - and a real mitral repair or replacement, done at a UK centre that does them in volume.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What private endoscopic mitral surgery costs in the UK.

Indicative all-in ranges across UK partner centres. Send the echo and we return firm figures for two or three units.

In short

£38,000–£58,000, home in 4–6 days.

Procedure Indicative range
Endoscopic mitral valve repair (all-in) £38,000–£58,000
Endoscopic mitral valve replacement (biological) £40,000–£62,000
Endoscopic mitral valve replacement (mechanical) £40,000–£62,000
Robotic (da Vinci) mitral repair - select centres £48,000–£75,000
Conventional sternotomy mitral repair (comparator) £32,000–£48,000
Surgical consultation and TOE workup £600–£1,400

Prices vary by centre, by the surgeon and anaesthetist, by the prosthesis chosen, and by whether concomitant procedures (AF ablation, left atrial appendage clip, tricuspid repair) are added.

The problem

The right centre, the right approach, the right valve strategy.

Mitral surgery is one of the most operator-dependent procedures in cardiac medicine. The unit and the surgeon matter more than the marketing - and the choice between repair, replacement, MitraClip or sternotomy has to be made honestly, not by default.

  • Sternotomy, endoscopic or robotic?

    Not every mitral valve is suitable for the mini approach. We map your anatomy against each unit’s comfort zone.

  • Surgery or MitraClip?

    TEER (MitraClip) is right for high-risk patients, wrong for younger ones with repairable disease. We help you sort which is which.

When it helps

When endoscopic mitral surgery is the right step.

The mitral pathologies we see most, and the one presentation that means an emergency admission rather than an outpatient pathway.

  • Severe degenerative MR (Barlow’s)

    A billowing, myxomatous valve with prolapse of multiple segments - the classical repair candidate.

  • Fibroelastic deficiency (FED)

    A thin, chord-poor valve with a single ruptured chord and P2 prolapse - the highest repair success rates in the UK.

  • Symptomatic severe MR

    Breathlessness on exertion, orthopnoea, palpitation or new atrial fibrillation with severe MR on echo.

  • Asymptomatic severe MR with triggers

    LV dilatation, ejection fraction <60%, pulmonary hypertension, or new AF - the EACTS/SCTS thresholds for surgery.

  • Functional/ischaemic MR (selected)

    Some ischaemic and secondary MR is treated surgically - most is not, and TEER (MitraClip) may fit better. We help you sort which is which.

  • Younger patients, active lives

    A 4–5 cm right-side scar, no sternal precautions, and back to work in weeks rather than months.

  • Previous sternotomy

    A right mini-thoracotomy avoids re-entering a scarred sternum - often the safer route for redo mitral surgery.

  • Red flag: acute severe MR

    Sudden breathlessness and pulmonary oedema after a chordal rupture or endocarditis is an emergency - A&E, not a clinic booking.

Procedure options

The endoscopic mitral toolbox - and its neighbours.

What each option actually involves, and which valve pathology it fits - including the transcatheter alternatives that are not surgery at all.

  • Endoscopic mitral repair

    Ring annuloplasty with PTFE neochords, resection, cleft closure or edge-to-edge repair through a 4–5 cm right mini-thoracotomy with 3D endoscopy.

  • Endoscopic mitral replacement

    A biological (Perimount, Epic, Trifecta) or mechanical (Carbomedics, St Jude, On-X) prosthesis implanted through the same minimally invasive access.

  • Robotic (da Vinci) mitral repair

    Available in a small number of UK centres. Similar recovery to endoscopic, with three keyhole ports plus a working incision.

  • Alfieri edge-to-edge repair

    The two mitral leaflets are stitched together at the site of the leak - used when segmental repair is not feasible. The surgical ancestor of the MitraClip.

  • Concomitant AF ablation and LAA clip

    A left atrial cryo- or radiofrequency maze and left atrial appendage exclusion (AtriClip) added when atrial fibrillation is present.

  • Transcatheter edge-to-edge (TEER)

    A MitraClip is not surgery - it is a catheter procedure for patients who are too high risk for open repair. Different pathway, different team.

  • Transcatheter mitral replacement

    A distinct, largely investigational pathway. Only a handful of UK sites offer it, and only for selected anatomy.

  • Conventional sternotomy

    Still the right answer for complex bileaflet disease, concomitant coronary surgery, or where the mini approach adds risk. We are honest about when.

Safety and recovery

The honest risk picture - and what mitigates it.

Endoscopic mitral surgery is safe in experienced hands, but it has a distinct risk profile - driven mostly by peripheral cardiopulmonary bypass and the femoral cannulation.

  • Retrograde perfusion stroke - 1–3%

    Peripheral bypass runs blood backwards up the aorta. In an atheromatous aorta this can dislodge debris. CT screening beforehand and, in some cases, an endoaortic balloon or transthoracic clamp lower the risk.

  • Aortic dissection - under 0.5%

    A rare but serious complication of femoral cannulation. Careful CT vetting and TOE monitoring during cannulation are the mitigations.

  • Femoral vessel complications

    Bruising, seroma, lymphocoele or, rarely, arterial injury. Closed with a small groin incision; longer-term issues are uncommon.

  • Phrenic nerve injury

    The right phrenic nerve sits near the mitral valve. Transient diaphragm weakness is uncommon and usually recovers.

  • Conversion to sternotomy - 2–5%

    A minority of cases are converted mid-operation for bleeding, poor exposure or unexpected anatomy. Consented for from the outset.

  • Repair failure

    Around 1–2% of durable repairs need reintervention within a year, and 5–10% within a decade. Higher for complex bileaflet disease.

  • Endocarditis and prosthesis infection

    Rare but serious. Dental and antibiotic prophylaxis rules are explained at discharge and should be followed for life.

  • Venous thromboembolism and AF

    Prophylactic anticoagulation, early mobilisation and cardiac rehab reduce clot risk. New AF in the first weeks is common and usually manageable.

  • Red flags after discharge

    Fever, spreading redness at the wound, sudden breathlessness, chest pain or leg swelling are not normal - call the unit or A&E the same day.

Reading your operation note

Your operation note in four parts. Read the last one first.

Whichever approach and prosthesis were used, the note the surgeon sends you keeps to the same shape.

A UK consultant cardiac surgeon reviewing a patient’s operation notes

A quiet reminder

Cardiac surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your six-week echo, just ask.

  1. 01 Header

    Indication, valve pathology and approach

    The reason for surgery - degenerative, functional or ischaemic MR - and the access used: right mini-thoracotomy, robotic or sternotomy.

  2. 02 Technique

    What was done to the valve

    Ring size and manufacturer, number and location of PTFE neochords, whether the cleft was closed, and (if replaced) the exact prosthesis and size.

  3. 03 Findings

    CPB, cross-clamp times and TOE result

    Bypass and clamp times, weaning from CPB, and the intra-operative TOE confirming no or trivial residual MR and no gradient across the valve.

  4. 04 Impression

    Recovery plan, medications and reviews

    Read this first: cardiac rehab schedule, anticoagulation (warfarin for mechanical valves, 3 months for tissue valves and repair), and echo follow-up at 6 weeks, 6 months and yearly.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Cover for mitral valve surgery is usually approved when medically indicated.

Frequently asked

Everything we get asked about endoscopic mitral valve surgery.

Straight answers on repair vs replacement, MitraClip, valve types, UK centres and recovery.

  • What is endoscopic (minimally invasive) mitral valve surgery?

    A mitral valve repair or replacement done through a 4–5 cm incision between the ribs on the right side of the chest, using a 3D endoscope, long-shafted instruments and peripheral cardiopulmonary bypass. The sternum is not opened.

  • Which UK centres do endoscopic mitral surgery well?

    Royal Brompton, St George’s (London), Wythenshawe (Manchester), Papworth (Cambridge), Leeds General Infirmary, Freeman (Newcastle) and Barts Heart Centre all run high-volume minimally invasive mitral programmes. A small number also offer the robotic (da Vinci) variant.

  • Repair or replacement - which will I have?

    For degenerative disease (Barlow’s, fibroelastic deficiency) repair is preferred and durable - the SCTS and EACTS guidelines are explicit about this. Replacement is reserved for valves that cannot be repaired safely, for rheumatic disease and for some cases of functional MR.

  • Biological or mechanical valve?

    A biological valve (Perimount, Epic, Trifecta) avoids lifelong warfarin but wears out over 10–20 years. A mechanical valve (Carbomedics, St Jude, On-X) lasts decades but needs lifelong warfarin with INR monitoring. The choice is driven by your age, lifestyle and preference.

  • Is endoscopic surgery the same as MitraClip (TEER)?

    No. MitraClip (transcatheter edge-to-edge repair) is a catheter procedure done through the groin without opening the chest, and is used for patients who are too high risk for surgery. Endoscopic mitral surgery is real cardiac surgery - with better durability but higher operative risk.

  • What is the recovery like compared with a sternotomy?

    Typical recovery to normal activity is 4–6 weeks after a mini-thoracotomy versus 8–12 weeks after a sternotomy. There are no sternal precautions - you can drive, lift and sleep on your side sooner - and the scar is a discrete right-sided line.

  • What are the risks that are specific to the minimally invasive approach?

    Retrograde perfusion stroke (1–3%), aortic dissection (<0.5%), femoral vessel complications, phrenic nerve injury, and conversion to sternotomy in 2–5% of cases. Careful CT screening and experienced teams reduce all of these.

  • How much does private endoscopic mitral surgery cost in the UK?

    Roughly £38,000–£58,000 all-in for a mini repair and £40,000–£62,000 for a mini replacement. Robotic mitral repair sits at £48,000–£75,000.

  • Are outcomes tracked?

    Yes. All UK cardiac units submit outcomes to NICOR (National Cardiac Audit Programme). We can share unit-level repair rates, 30-day mortality and stroke rates before you commit.

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