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Ann Thorac Surg 2007;83:2261-2262
© 2007 The Society of Thoracic Surgeons

Correspondence

Edge-to-Edge Mitral Valve Repair: A "Safe and Useful" Technique?

Lishan Aklog, MD, Brian J. deGuzman, MD

The Heart & Lung Institute, St. Joseph’s Hospital and Medical Center, 500 W Thomas Rd, Suite 500, Phoenix, AZ 85013

(Email: lishan.aklog{at}chw.edu).

To the Editor:

Although we commend Kudvalli and associates [1] for a thorough analysis of their results in 41 patients undergoing edge-to-edge mitral valve repair. We were surprised by their conclusion that it is "a safe and useful technique." Only 25 (61%) of their patients can be described as having had a successful procedure during a median follow-up of well less than 2 years. The other 16 patients (39%) either died in the immediate postoperative period (2 patients), required immediate reoperation (2 patients), required early reoperation (2 patients), had ≥2+ residual mitral regurgitation (6 patients), or had at least a New York Heart Association functional class III heart failure (4 patients). As the vast majority of these patients had a degenerative cause, the results (median, 19 months) need viewed in context of Carpentier’s very long-term results [2] (median, 19 years). We remain puzzled that despite a solid evidence base documenting its inferiority, some centers continue to embrace edge-to-edge techniques for a disease in which well-established techniques with outstanding very long-term results are available. It is even more disconcerting that this base of surgical support is being leveraged to justify the percutaneous application of edge-to-edge repair.


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 References
 

  1. Kuduvalli M, Ghotkar SV, Grayson AD, Fabri BM. Edge-to-edge technique for mitral valve repair: medium-term results with echocardiographic follow-up Ann Thorac Surg 2006;82:1356-1361.[Abstract/Free Full Text]
  2. Braunberger E, Deloche A, Berrebi A, et al. Very long-term results (more than 20 years) of valve repair with Carpentier’s techniques in nonrheumatic mitral valve insufficiency Circulation 2001;104(I):8-11.




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