The edge-to-edge technique for mitral valve repair

摘要

The edge-to-edge technique was introduced in the surgical armamentarium of mitral valve repair in 1991 and has progressively been used to restore mitral competence in the setting of degenerative, post-endocarditis and functional mitral regurgitation. Appropriate indications and awareness of the important technical aspects of the procedure are prerequisites for a good outcome. The free edges of the mitral leaflets have to be approximated in correspondence of the site of the regurgitant jet in such a way that mitral regurgitation is corrected without producing stenosis. A prosthetic ring is usually implanted to stabilize the repair. Middle and long-term results are now available for degenerative mitral regurgitation (bileaflet prolapse, anterior leaflet prolapse and commissural prolapse). Of particular interest is the finding that the edge-to-edge technique for correction of anterior leaflet prolapse is providing a freedom from reoperation similar to that obtained in patients with posterior leaflet prolapse treated with quadrangular resection. Degenerative or post-endocarditis commissural prolapse/flail of the mitral valve can be effectively corrected by this technique. In patients with functional mitral regurgitation, the use of the edge-to-edge repair, added to the undersized annuloplasty, has been associated with a significantly lower recurrence of mitral regurgitation in the follow-up compared to isolated undersized annuloplasty. Almost 20 years after its introduction, the edge-to-edge technique remains an effective and versatile method to treat mitral regurgitation. Its simplicity and reproducibility have led to its clinical application by percutaneous methods opening a new age in the fascinating field of reconstructive mitral valve surgery.