{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T09:59:56Z","timestamp":1775728796072,"version":"3.50.1"},"reference-count":19,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T00:00:00Z","timestamp":1775692800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medical Sciences"],"abstract":"<jats:p>Background\/Objectives: Totally endoscopic mitral valve repair reduces surgical trauma and accelerates recovery but can be technically challenging, particularly for precise annuloplasty suturing. The VirtuoSEW\u00ae (LSI Solutions, Victor, NY 14564m, USA) automated annular suturing system was developed to standardize and simplify suture placement. This study was an early evaluation of this technology\u2019s safety, efficacy, and feasibility in totally endoscopic microInvasive mitral valve repair (\u00b5MVr). Methods: We conducted a retrospective observational study of 20 patients with severe mitral valve disease of various etiologies. All patients underwent mitral valve repair using the VirtuoSEW\u00ae system for automated placement of annuloplasty sutures, combined with leaflet resection or chordal management as appropriate. Postoperative outcomes were assessed at one month using echocardiography and clinical evaluation. Perioperative and postoperative complications and early mortality were systematically recorded. Results: VirtuoSEW\u00ae-assisted mitral valve repair was safe and effective, achieving complete elimination of severe mitral regurgitation in all patients (N = 20, 100%). Annuloplasty rings included Physio-ring (N = 12, 60%), Memo 3D (N = 4, 20%), and Memo 4D (N = 4, 20%), combined with leaflet repair techniques: leaflet plication (N = 5, 25%), neochordae implantation (N = 7, 35%), sliding plasty (N = 2, 10%), commissural repair (N = 1, 5%), and hemibutterfly repair (N = 1, 5%). Concomitant procedures included: tricuspid valve repair (N = 1, 5%) and atrial septal defect closure (N = 1, 5%). Mitral annulus diameter decreased from 42.0 \u00b1 5.3 mm to 34.2 \u00b1 2.2 mm (p = 0.001). Mean total surgery, cardiopulmonary bypass, and aortic cross-clamp times were 170.3 \u00b1 21.3, 143.4 \u00b1 21.5, and 80.4 \u00b1 7.9 min, respectively. ICU stay was 1.0 \u00b1 0.2 days, with a hospital stay of 8.0 \u00b1 1.9 days. No perioperative complications\u2014including bleeding (N = 0, 0%), stroke (N = 0, 0%), infections (N = 0, 0%), or 30-day mortality (N = 0, 0%)\u2014occurred. Conclusions: \u00b5MVR invasive mitral valve repair using the VirtuoSEW\u00ae system is safe, effective, and reproducible, as well as compatible with almost all repair techniques, providing complete restoration of valve competence with no early device-related complications. To our knowledge, this is the first clinical study reporting outcomes with this device, supporting its potential to streamline mitral repair and improve procedural efficiency.<\/jats:p>","DOI":"10.3390\/medsci14020187","type":"journal-article","created":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T08:56:07Z","timestamp":1775724967000},"page":"187","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Automated Annuloplasty with VirtuoSEW\u00ae in microInvasive Mitral Valve Repair (\u03bcMVr)"],"prefix":"10.3390","volume":"14","author":[{"given":"Nermir","family":"Granov","sequence":"first","affiliation":[{"name":"Clinic for Cardiovascular Surgery, Clinical Center of University of Sarajevo, Bolni\u010dka 25, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Farhad","family":"Bakhtiary","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Bonn, 53127 Bonn, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2865-0446","authenticated-orcid":false,"given":"Armin","family":"\u0160ljivo","sequence":"additional","affiliation":[{"name":"Clinic for Cardiovascular Surgery, Clinical Center of University of Sarajevo, Bolni\u010dka 25, 71000 Sarajevo, Bosnia and Herzegovina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2280-9244","authenticated-orcid":false,"given":"Jude S.","family":"Sauer","sequence":"additional","affiliation":[{"name":"LSI Solutions, Victor, NY 14564, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1016\/j.athoracsur.2016.01.084","article-title":"Minimally Invasive Mitral Valve Surgery Provides Excellent Outcomes Without Increased Cost: A Multi-Institutional Analysis","volume":"102","author":"Downs","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"943","DOI":"10.1016\/j.ejcts.2008.07.057","article-title":"Minimally invasive mitral valve surgery: A systematic review and meta-analysis","volume":"34","author":"Modi","year":"2008","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_3","first-page":"ivae112","article-title":"First experiences with automated annular suturing device in totally endoscopic aortic and mitral valve replacement","volume":"38","author":"Salamate","year":"2024","journal-title":"Interdiscip. Cardiovasc. Thorac. Surg."},{"key":"ref_4","first-page":"91","article-title":"Comparison between conventional open-heart valve surgery and minimally invasive valve replacement surgery regarding length of hospital stay and use of blood derivates: Insights from a single-centre, single-surgeon study in Bosnia and Herzegovina","volume":"21","author":"Granov","year":"2024","journal-title":"Med. Glas."},{"key":"ref_5","unstructured":"LSI Solutions, Inc. (2026). VirtuoSEW\u2122 Device, LSI Solutions. Available online: https:\/\/www.lsisolutions.com\/products\/virtuosew."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Pradhan, A., Bhandari, M., Vishwakarma, P., Salimei, F.I., Sethi, R., and Perrone, M.A. (2023). Anticoagulation for Left Ventricle Thrombus-Case Series Literature Review for use of Direct Oral Anticoagulants. J. Cadrdiovasc. Dev. Dis., 10.","DOI":"10.3390\/jcdd10020041"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1007\/s11886-021-01552-w","article-title":"Update in Paravalvular Leak Closure","volume":"23","author":"Desai","year":"2021","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1007\/s11936-019-0776-6","article-title":"Paravalvular Leaks-From Diagnosis to Management","volume":"21","author":"Bernard","year":"2019","journal-title":"Curr. Treat. Options Cardiovasc. Med."},{"key":"ref_9","unstructured":"The Society of Thoracic Surgeons (2025). STS ACSD Operative Risk Calculator, The Society of Thoracic Surgeons. Available online: https:\/\/acsdriskcalcm.research.sts.org\/."},{"key":"ref_10","first-page":"2025","article-title":"Total endoscopic valve surgery with the Ram device in combined mitral and tricuspid valve disease","volume":"2","author":"Baysal","year":"2025","journal-title":"Multimedia Man. Cardio-Thoracic. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"196","DOI":"10.1177\/15569845241237537","article-title":"Implementation of endoscopic minimally invasive mitral valve replacement surgery with automated suturing technology","volume":"19","author":"Zubarevich","year":"2024","journal-title":"Innovations"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1177\/15569845221133381","article-title":"Novel automated suturing technology for minimally invasive mitral chord implantation: A preclinical evaluation study","volume":"17","author":"Werner","year":"2022","journal-title":"Innovations"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1016\/j.ejcts.2008.01.013","article-title":"Early and mid-term results of mitral valve repair using premeasured Gore-Tex loops (\u2018loop technique\u2019)","volume":"33","author":"Kuntze","year":"2008","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Poschner, T., Laengle, S., Tasdelen, S., Suria, A., Baysal, F., Kocher, A., and Andreas, M. (2024). Innovative mitral valve repair using a novel automated suturing system: Preliminary data. Medicina, 60.","DOI":"10.3390\/medicina60071138"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.athoracsur.2023.10.014","article-title":"Evaluation of a novel automated suturing technology for mitral chordal implantation: 1-year results","volume":"117","author":"Werner","year":"2024","journal-title":"Ann. Thorac. Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"914","DOI":"10.1016\/j.jacc.2013.07.090","article-title":"Off-pump transapical implantation of artificial neo-chordae to correct mitral regurgitation: The TACT Trial (Transapical Artificial Chordae Tendinae) proof of concept","volume":"63","author":"Seeburger","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jacc.2017.10.062","article-title":"Beating-heart mitral valve repair using a novel ePTFE chordal implantation device: A prospective trial","volume":"71","author":"Gammie","year":"2018","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1093\/ejcts\/ezy046","article-title":"Learning curve analysis of transapical NeoChord mitral valve repair","volume":"54","author":"Colli","year":"2018","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2039","DOI":"10.1016\/j.jcin.2016.07.005","article-title":"Transcatheter mitral annuloplasty in chronic functional mitral regurgitation: 6-month results with the Cardioband percutaneous mitral repair system","volume":"9","author":"Nickenig","year":"2016","journal-title":"JACC Cardiovasc. Interv."}],"container-title":["Medical Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/187\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,9]],"date-time":"2026-04-09T09:11:19Z","timestamp":1775725879000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3271\/14\/2\/187"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,9]]},"references-count":19,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["medsci14020187"],"URL":"https:\/\/doi.org\/10.3390\/medsci14020187","relation":{},"ISSN":["2076-3271"],"issn-type":[{"value":"2076-3271","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,9]]}}}