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Totally Endoscopic Aortic Valve Replacement and Transaortic Mitral Valve Repair

Tuesday, February 4, 2020

Pitsis A, Tsotsolis N, Nikoloudakis N, Keremidis I, Boudoulas H, Boudoulas KD. Totally Endoscopic Aortic Valve Replacement and Transaortic Mitral Valve Repair. February 2020. doi:10.25373/ctsnet.11689443.

The authors present the case of a 77-year-old woman in NYHA class 3, due to severe AS and severe secondary MR. The operation was performed with the authors’ totally endoscopic technique, which has been previously published on CTSNet (1-4). A 3D 30-degrees Karl Storz endoscope was used. Under stereoscopic vision, the mitral valve was approached through the aortotomy after the excision of the calcific aortic valve. A self-expanding metal net (Fehling) was deployed in the aortic annulus in order to facilitate the exposure of the mitral valve leaflets and subvalvar apparatus. A horizontal mattress Teflon buttressed CV4 Gore-Tex suture was used to capture the middle of the P2 and A2 segments of the mitral valve. Then, the Trifecta (Abbott) aortic prostheses was inserted over 12 Ethibond sutures and secured using the Cor-Knot device.

Postoperative TOE confirmed a well-functioning aortic prosthesis and a satisfactory mitral valve repair with less than 1+ MR, a peak mitral gradient of 5.9 mmHg and a valve area of 3.2 cm2. Cross-clamp and CPB times were 91 and 123 minutes respectively.

The authors believe that this technique is indicated in cases of severe secondary mitral regurgitation due to dilated cardiomyopathy secondary to aortic valve disease.


  1. Pitsis A, Tsotsolis N, Nikoloudakis N, Kelpis T, Economopoulos V, Keremidis I. Totally endoscopic aortic valve replacement with a Trifecta GT bovine pericardial valve. CTSNet. August 2019. doi:10.25373/ctsnet.9587900.
  2. Pitsis A, Tsotsolis N, Nikoloudakis N, Economopoulos V. Totally endoscopic mitral valve repair with predetermined length of synthetic chordae. CTSNet. November 2019. doi:10.25373/ctsnet.10070126.
  3. Pitsis A, Tsotsolis N, Nikoloudakis N, Economopoulos V, Kelpis T. Totally endoscopic redo tricuspid valve repair. CTSNet. June 2019. doi:10.25373/ctsnet.8199260.
  4. Pitsis A, Nikoloudakis N, Tsotsolis N, Economopoulos V, Kelpis T, Keremidis I, et al. Totally endoscopic bileaflet mitral valve repair with preformed chordae loops. CTSNet. March 2019. doi:10.25373/ctsnet.7837853.


Antonios Pitsis serves as a consultant for Abbott and Medtronic.


The information and views presented on represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.


Thank you Dr. Bajona. The metal net is made by Fehling and it is called SUPERFLEX SOFT TISSUE RETRACTOR 200 x 25 mm MTI-0. It is one model that it was developed for atrial use, but I have found it to be very useful in many types of totally endoscopic cardiac surgery for the aortic root (AVRs), aortic annulus (HCM surgery - that I know interests you a lot - and transaortic MVRepairs), ventricles (VSDs) and so on. Also when the sutures get tangled, you can put the net in the middle and it helps you to solve the problem.

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