Surgical isolated edge-to-edge mitral valve repair without annuloplasty: clinical proof of the principle for an endovascular approach

Abstract

Aims: A variety of endovascular technologies for valve repair for mitral regurgitation (MR) are under development. Endovascular Edge-to-Edge (E2E) approach recently entered the clinical trial phase. The aim of the present study was to determine the effectiveness of surgical isolated E2E repair without annuloplasty to predict the efficacy of the endovascular E2E approach.

Methods and results: Clinical and echocardiographic data of 29 patients with either degenerative or functional MR who had surgical E2E repair without annuloplasty, were retrospectively analysed. Mean age was 63.8+/-8.79 years, 45% were in NYHA class III or IV and 41% had a left ventricular ejection fraction less than 60%. Hospital mortality was 3.4% and overall survival after a mean follow-up of 6.8 year was 93%. At latest follow-up, 68% of patients were in NYHA class I, 28% in class II and 4% in class III; 86% of patients had MR < grade 2. Two patients with recurrent grade 4 MR underwent re-operation. The 5 years freedom from the combined end-point of recurrent MR>2+ and re-operation, was 90+/-5%.

Conclusions: Isolated surgical E2E mitral repair, intentionally performed without annuloplasty, has acceptable midterm results for degenerative and functional MR, comparable to conventional repair techniques with annuloplasty. These results encourage the evaluation of less invasive endovascular E2E repair approaches in a clinical setting.