Totally endoscopic beating-heart redo tricuspid valve replacement using a frame-preserving strategy: a case report

Background: Redo tricuspid valve surgery for structural bioprosthetic degeneration is technically challenging and carries substantial operative risk, particularly after previous sternotomy. Totally endoscopic approaches may reduce re-entry-related morbidity, but experience in redo tricuspid surgery remains limited. In selected cases, preserving a well-incorporated bioprosthetic frame may avoid extensive annular dissection. Case presentation: A 46-year-old man presented with progressive right-sided heart failure 11 years after tricuspid bioprosthetic valve replacement for infective endocarditis. Echocardiography showed severe intra-prosthetic regurgitation and stenosis with calcified, retracted leaflets. Transcatheter valve-in-valve therapy was considered but not selected because of the patient’s young age, durability concerns, limited availability, and cost. Totally endoscopic beating-heart redo tricuspid valve replacement was performed through a right mini-thoracotomy under peripheral cardiopulmonary bypass. The degenerated leaflets were excised, the sewing ring was preserved, and a 29-mm mechanical prosthesis was implanted onto the retained frame. Recovery was uneventful, and valve function was normal at 6 months. Conclusion: This frame-preserving, totally endoscopic approach is feasible in selected patients, although further experience is needed.