Total endoscopic valve surgery with the Ram device in combined mitral and tricuspid valve disease

Total endoscopic valve surgery is considered safe and efficient, providing multiple advantages and significantly increasing patient satisfaction. However, prolonged surgical times due to high technical complexity may remain. Devices for automated suturing may address this problem. The following case report demonstrates our step-by-step approach for combined total endoscopic mitral valve replacement using the RAM technology and tricuspid valve repair in a patient with severe rheumatic mitral valve stenosis.