Edge-to-edge surgical mitral valve repair in the era of mitraClip: What if the annuloplasty ring is missed?

The surgical edge-to-edge technique should always be combined with prosthetic ring annuloplasty in order to provide excellent long-term outcomes in patients with degenerative mitral regurgitation. The overall longterm results of the surgical edge-to-edge technique without annuloplasty are not satisfactory. The ringless edge-to-edge technique is not effective in the challenging setting of extensively calcified annulus. In patients without annular calcification, in whom annuloplasty was intentionally avoided, the ringless edge-to-edge repair provides acceptable results in the mid term but is associated with a high failure rate in the long term. In the MitraClip perspective, these findings emphasize the need for a reliable annuloplasty to improve the long-term outcomes of the currently available transcatheter edge-to-edge procedure.