Edge-to-edge surgical mitral valve repair in the era of MitraClip

what if the annuloplasty ring is missed?

Abstract

Purpose of review 

The purpose of this review is to define the role of annuloplasty in the surgical edge-to-edge repair, an issue that seems particularly relevant in the current MitraClip era, when more than 15 000 patients have been submitted to a percutaneous transcatheter edge-to-edge repair without concomitant annuloplasty.

Recent findings 

Only a few studies have reported the clinical and echocardiographic outcomes of the ringless edge-to-edge mitral repair. In all of them, however, only mid-term data were provided. Recently, the long-term results of the surgical edge-to-edge procedure performed without a concomitant annuloplasty in a selected group of patients with degenerative mitral regurgitation have been published.

Summary 

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 long-term 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.