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Ann Thorac Surg 2007;83:724-725
© 2007 The Society of Thoracic Surgeons

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Correspondence

Reply

Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115

(Email: derekbrinster{at}yahoo.com).

To the Editor:

I would like to thank Dr Muthialu [1] for his insightful analysis regarding our article [2]. Although standard mitral valve repair techniques, including leaflet resection, leaflet advancement, chordal shortening, and insertion of an annuloplasty ring are usually sufficient, the edge-to-edge technique (E2E) was used in this small group of patients with very complex valves after complex repair of the myxomatous valve.

The objective of our article was to examine the single institution use of the E2E technique. Two groups were identified that had the E2E repair. The first group was comprised of 52 of 1,607 patients (3.2%) with residual post-bypass MR after standard mitral valve repair techniques. The second group included 20 patients (1.2%) who had the E2E repair as an adjunct to standard mitral valve repair due to our echocardiogram evaluation of the high risk of systolic anterior motion (SAM) of the anterior leaflet. Although both groups had excellent early reduction in MR, the first group had a relatively high incidence of recurrent MR on follow-up transthoracic echocardiogram.

Doctor Muthialu [1] is correct that the two groups are heterogenous. Although other studies have demonstrated prospectively that the E2E repair provides a durable repair for myxomatous disease, this study does not demonstrate durability when performed as a "bailout." However, the second subgroup had complete correction of all SAM potential using the E2E technique. Therefore, as Muthialu [1] suggested, the highlight of this article is the use of E2E as a favored repair technique for those patients with high SAM potential. Further evaluation with a larger study will be needed to truly address the long-term durability of the E2E repair for myxomatous disease.

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1. Muthialu N. Edge-to-edge technique for residual mitral valve regurgitation (letter) Ann Thorac Surg 2007;83:724.[Free Full Text]
2. Brinster DR, Unic D, D’Ambra MN, et al. Midterm results of the edge-to-edge technique for complex mitral valve repair Ann Thorac Surg 2006;81:1612-1617.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Derek R. Brinster Lawrence H. Cohn Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Brinster, D. R. Articles by Cohn, L. H. Search for Related Content PubMed Articles by Brinster, D. R. Articles by Cohn, L. H. Related Collections Related Article