Standardized totally endoscopic non-robotic mitral valve repair for degenerative mitral regurgitation: Early single-center outcomes in 84 patients

Objective: To evaluate early clinical and echocardiographic outcomes of totally endoscopic, non-robotic mitral valve repair for degenerative mitral regurgitation using a standardized DCT approach (double-port; camera and main working port in the same intercostal space; skin incision <3 cm), and to propose operational criteria for "totally endoscopic" mitral surgery. Methods: In this single-center observational study, 84 consecutive patients with severe degenerative mitral regurgitation meeting 2021 ESC/EACTS surgical criteria underwent totally endoscopic non-robotic repair with three-dimensional visualization between July 2023 and January 2026. The technique used a primary skin incision <3 cm with no rib spreading in all cases. Clinical and echocardiographic outcomes within 30 days were assessed. Results: Repair was successful in all 84 patients (100%), without conversion to sternotomy or replacement. All underwent ring annuloplasty; neochordal implantation was performed in 69 (82.1%). Mean incision length was 2.9 ± 0.3 cm. Mean cardiopulmonary bypass and cross-clamp times were 163.3 ± 50.5 and 112.1 ± 37.5 minutes. There was no 30-day mortality. Major complications each occurred in 1 patient (1.2%): re-exploration for bleeding, intracranial hemorrhage, and femoral artery occlusion. Median intensive care unit and hospital stays were 2 (IQR 2–3) and 10 (IQR 9–14) days. Echocardiography showed no residual regurgitation ≥ moderate and preserved ventricular function in all patients. Conclusions: Standardized totally endoscopic non-robotic mitral valve repair using the DCT approach was feasible and reproducible, achieving a 100% repair rate with favorable early outcomes. Given the single-center design and short follow-up, these should be interpreted as feasibility data.