This video showcases a totally endoscopic mitral valve replacement (TE-MVR) using a transcatheter device in a patient with a history of mitral commissurotomy. The procedure was performed using a minimally invasive, port-access approach, ensuring precision and reducing surgical trauma. 

The patient, who had previously undergone mitral commissurotomy, presented with severe mitral valve dysfunction, necessitating valve replacement. Given the history of prior intervention, the surgical team carefully navigated fibrotic and calcified tissue, to ensure optimal prosthetic valve positioning. 

The transcatheter device, a specialized tool designed for precise and efficient valve implantation, facilitated a controlled and reproducible procedure. The endoscopic approach allowed for enhanced visualization, enabling meticulous dissection, valve excision, and implantation while maintaining a minimally invasive footprint. 

Key procedural steps included: port placement and initiation of cardiopulmonary bypass, minimally invasive exposure of the mitral valve, valve excision and annular preparation, and  deployment of the new mitral prosthesis using the transcatheter device. 

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