In patients with mitral regurgitation (MR) secondary to ischemic or non-ischemic dilated cardiomyopathy, valve repair is usually performed by means of an undersized annuloplasty. This procedure leads to symptomatic improvement and reverse left ventricular (LV) remodeling in a substantial proportion of patients. However, the failure rate of undersized annuloplasty is still high and is mainly due to inappropriate patient selection and to technical issues which have been progressively identifi ed. Annuloplasty alone should only be carried out in the early phase of the disease before the occurrence of advanced LV remodeling and echocardiographic predictors of unfavourable outcome should be taken into account. Under certain circumstances, in particular when tethering is more pronounced, surgery should include additional procedures beside annuloplasty to enhance the durability of the repair. The edge-to-edge (EE) technique has been used in our Institution for this purpose. Herein we will report what we have learned over the years by using this method of repair as an adjunct to undersized annuloplasty in patients with functional mitral regurgitation.
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