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Ann Thorac Surg 2006;81:1612-1617
© 2006 The Society of Thoracic Surgeons

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Original article: Cardiovascular

Midterm Results of the Edge-to-Edge Technique for Complex Mitral Valve Repair

Division of Cardiac Surgery and Cardiac Anesthesia, Brigham and Women's Hospital, and the Department of Surgery and Anesthesia, Harvard Medical School, Boston, Massachusetts

Accepted for publication December 1, 2005.

^_* Address correspondence to Dr Cohn, Division of Cardiac Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115; (Email: lcohn{at}partners.org).

BACKGROUND: The edge-to-edge technique (E2E) has been advocated for the complex repair of myxomatous mitral valves. We compared outcomes of E2E performed in patients at risk for systolic anterior motion (SAM) versus outcomes in patients with residual mitral regurgitation (MR) after repair completion.

METHODS: A total of 1,612 patients had repair of myxomatous mitral valves between June 1997 and December 2003 at Brigham and Women's Hospital. The E2E was used in 72 (4.5%) patients. Fifty-two patients (52/72; group I) had E2E for persistent MR after complex repair. Twenty patients (20/72; group II) had E2E for high risk of post-repair SAM and left ventricular outflow tract obstruction. Mean age of the patients was 61 ± 14 years; 47 were male, average New York Heart Association class at admission was 2.4 ± 0.6, and mean left ventricular ejection fraction was 56 ± 12%.

RESULTS: The operative mortality was zero. Immediate postoperative MR was significantly improved in all patients compared with the preoperative grade (p value < 0.0005). Mean follow-up was 388 days. In those in whom E2E was used for residual MR without SAM risk (group I), postoperative MR ( 2+) was detected in 15 of 52 patients at 6 months. In group II, SAM was completely eliminated and the mean MR grade in the immediate postoperative period was 0.5 ± 0.7. There was no long-term recurrence of MR in group II.

CONCLUSIONS: This study suggests that E2E eliminates SAM and long-term MR in patients with pre-repair echocardiographic predictors of SAM. The E2E is not efficacious in preventing long-term recurrent MR if performed for residual MR after complex mitral repair.

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Invited commentary

Robert Dion
Ann. Thorac. Surg. 2006 81: 1617. [Extract] [Full Text] [PDF]

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