Can the edge-to-edge technique provide durable results when used to rescue patients with suboptimal conventional mitral repair?

Michele De Bonis, Elisabetta Lapenna, Nicola Buzzatti, Maurizio Taramasso, Maria Chiara Calabrese, Teodora Nisi, Federico Pappalardo, Ottavio Alfieri

Research output: Contribution to journalArticle

Abstract

Objectives: The 'edge-to-edge' technique (EE) can be used as a bailout procedure in case of a suboptimal result of conventional mitral valve (MV) repair. The aim of this study was to assess the long-term outcomes of this technique used as a rescue procedure. Methods: From 1998 to 2011, of 3861 patients submitted to conventional MV repair for pure mitral regurgitation (MR), 43 (1.1%) underwent a rescue edge-to-edge repair for significant residual MR at the intraoperative hydrodynamic test or at the intraoperative transoesophageal echocardiography. Residual MR was due to residual prolapse in 30 (69.7%) patients, systolic anterior motion in 12 (27.9%) and post-endocarditis leaflet erosion in 1 (2.3%). According to the location of the regurgitant jet, the edge-to-edge suture was performed centrally (60.5%) or in correspondence with the anterior or posterior commissure (39.5%). The original repair was left in place. Results: There were no hospital deaths. Additional cross-clamp time was 15.2 ± 5.6 min. At hospital discharge, all patients showed no or mild MR and no mitral stenosis. Clinical and echocardiographic follow-up was 97.6% complete (median length 5.7 years, up to 14.6 years). At 10 years, actuarial survival was 89 ± 7.4% and freedom from cardiac death 100%. Freedom from reoperation and freedom from MR ≥3+ at 10 years were both 96.9 ± 2.9%. At the last echocardiogram, MR was absent or mild in 37 patients (88%), moderate in 4 (9.5%) and severe in 1 (2.4%). No predictors for recurrence of MR ≥2+ were identified. The mean MV area and gradient were 2.8 ± 0.6 cm2 and 2.7 ± 0.9 mmHg. NYHA I-II was documented in all cases. Conclusions: A 'rescue' EE can be a rapid and effective option in case of suboptimal result of 'conventional' MV repair. Long-term durability of the repair is not compromised.

Original languageEnglish
Article numberezt056
JournalEuropean Journal of Cardio-thoracic Surgery
Volume43
Issue number6
DOIs
Publication statusPublished - Jun 2013

Keywords

  • Edge-to-edge technique
  • Mitral regurgitation
  • Mitral valve repair

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

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