Snare-Free Endoscopic Tricuspid Valve Repair Using a Percutaneous Venous Self-Expanding Cannula: A Descriptive Cohort Study

Background: Minimally invasive and endoscopic techniques have expanded the surgical options for tricuspid valve repair. Conventional approaches often require manual snaring of the venae cavae, which can increase procedural complexity, especially in advanced heart failure settings. This study describes a snare-free totally endoscopic approach to tricuspid valve repair utilizing percutaneous venous self-expanding cannulation. Methods: Between 2020 and 2025, 32 patients with severe tricuspid regurgitation (TR) underwent totally endoscopic tricuspid valve repair using a standardized snare-free technique. Venous drainage was achieved via predominantly percutaneous femoral cannulation with a self-expanding venous cannula, providing central venous decompression without external tourniquets or loops. All clinical, intraoperative, and early postoperative parameters were collected and analyzed using descriptive statistical methodology. Results: Snare-free cannulation was performed in all 32 patients (100.0%, 95% CI: 89.1–100.0%). Pure snare-free endoscopic repair was completed in 31 patients (96.9%, 95% CI: 83.8–99.9%), with one patient (3.1%) requiring conversion to full median sternotomy and manual caval snaring. The mean cardiopulmonary bypass (CPB) time was 145.9 ± 35.8 min, and the mean aortic cross-clamp duration was 92.4 ± 24.5 min. All-cause 30-day mortality was 3.1% (n = 1/32), and no cases of clinically documented hemolysis were observed (0.0%, 95% CI: 0.0–10.9%). The mean intensive care unit stay was 6.0 ± 4.9 days (n = 31), and the mean postoperative hospital length of stay was 15.3 ± 9.6 days (n = 30). Quantitative predischarge residual TR grades and transvalvular gradients were not systematically recorded; therefore, endoscopic completion in this cohort establishes cannulation feasibility rather than definitive valve-repair efficacy. Conclusion: Snare-free totally endoscopic tricuspid valve repair using percutaneous self-expanding venous cannulation appeared technically feasible and was associated with acceptable early clinical outcomes in this selected single-center cohort.