Endoscopic mitral valve replacement surgery in patients with previous closed mitral commissurotomy: A case series report

Objective: To describe the diagnostic features, surgical techniques, and outcomes of endoscopic mitral valve replacement in patients with a history of closed commissurotomy. Methods: This is a case series study of patients with a history of closed mitral commissurotomy who underwent totally endoscopic minimally invasive mitral valve replacement via the right anterior axillary approach at Hanoi Heart Hospital from May 2023 to May 2025. Results: This is a case series study was conducted on patients with a history of closed mitral commissurotomy who underwent minimally invasive mitral valve replacement via totally endoscopic right anterolateral thoracotomy at Hanoi Heart Hospital from May 2023 to May 2025. The study included 7 patients, with a mean age of 57.7 years (range 44–62). The average interval between the initial surgery and reoperation was 28.5 years (range 26–30 years). Mean aortic cross-clamp time: 58.8 minutes (range 40–65). Mean cardiopulmonary bypass time: 93.7 minutes (range 80–100). Mean operative time: 129.3 minutes (range 120–140). Mean mechanical ventilation time: 9 hours. Mean ICU stay: 2.5 days (range 2–3). Mean total hospital stay: 8.5 days (range 7–10). There were no in-hospital deaths, and no complications such as stroke, pneumonia, renal failure, or surgical site infection were observed. Conclusion: Totally endoscopic mitral valve replacement in patients with a history of closed mitral commissurotomy at Hanoi Heart Hospital is a feasible technique associated with low complication rates, reduced ICU and hospital stay, and favorable early outcomes. It should be considered for application in clinical practice.