This video is one of the top 10 entries from the 2025 Endoscopic Cardiac Surgeons Club Video Competition. More videos featuring these outstanding presentations will be showcased in the coming weeks [3].   

This video demonstrates the technique of using a periareolar incision around the nipple for access to perform endoscopic mitral valve surgery, a method that has been utilized by these authors for 20 years. It is important to perform the incision inside the areola and not in the transition to the skin in order to avoid scarring. Sharp dissection of the glandular tissue was performed, and then a soft tissue retractor was inserted. A 5 mm trocar was used in the fourth intercostal space, and a 5 mm scope was used. The left atrial retractor was also inserted. In the second intercostal space, a Chitwood clamp was used, and the heart was arrested using Custodiol. In this case, the patient had a small anteroposterior chest diameter. The case was performed with a triangular resection of P3, as neochords were not available in Brazil at that time. A sliding plasty was performed, and a full semirigid ring was used, resulting in a competent valve. After removal of the cross-clamp, the heart was deaired through a left ventricular (LV) vent and the aortic root. The rib was reapproximated with a figure-of-eight suture, and the pectoralis muscle was also reapproximated, along with the glandular tissue. To avoid scarring, the submammary tissue was closed, including the glandular tissue. The skin was closed with nylon interrupted sutures. The patient was extubated in the operating room after a 73-minute cross-clamp and was discharged on postoperative day three.  

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