title: Midterm results of edge-to-edge mitral valve repair without annuloplasty.
abstract: OBJECTIVE
  Edge-to-edge mitral valve repair is usually performed in association with annuloplasty, with rare exceptions. We retrospectively analyzed the results of ringless edge-to-edge repair, particularly in view of minimally invasive and percutaneous approaches.
  
  
  METHODS
  From November 1993 to December 2001, 81 patients underwent edge-to-edge mitral repair without associated annuloplasty. The cause was degenerative in most patients. In 32 patients the annulus was severely calcified. Type I lesions were present in 6 patients, type II lesions in 60 patients, and type III lesions in 15 patients. A double-orifice repair was done in 69 patients, and paracommissural repair was done in 12 patients. In 5 patients edge-to-edge repair was used as a rescue procedure.
  
  
  RESULTS
  There were 3 hospital and 4 late deaths, for a 4-year survival of 85% +/- 6.7%. At latest follow-up, 63 patients were in New York Heart Association classes I or II, and 9 patients were in classes III or IV. Nine patients required reoperation (89% +/- 3.9% overall freedom from reoperation at 4 years). Annular calcification was associated with a greater reoperation rate (77% +/- 22% vs 95% +/- 4.6% freedom from reoperation, P =.03). Intraoperative water testing and postrepair transesophageal echocardiography predicted late failure. Only 1 of 42 patients required reoperation in the follow-up period when annular calcification, rheumatic disease, or rescue procedure were not present as risk factors.
  
  
  CONCLUSIONS
  Our data confirm overall suboptimal results of the edge-to-edge technique when annuloplasty is not added to the repair. Annular calcification, rheumatic cause, and edge-to-edge repair done as a rescue procedure were associated with the worst outcome. Midterm results in selected patients encourage future developments in catheter-based edge-to-edge procedures.
authors.affiliation: Cardiac Surgery Division, IRCCS San Raffaele Hospital, Milan, Italy. francesco.maisano@hsr.it
authors.forename: Francesco
authors.initials: F
authors.lastname: Maisano
authors.forename: Alessandro
authors.initials: A
authors.lastname: Caldarola
authors.forename: Andrea
authors.initials: A
authors.lastname: Blasio
authors.forename: Michele
authors.initials: M
authors.lastname: De Bonis
authors.forename: Giovanni
authors.initials: G
authors.lastname: La Canna
authors.forename: Ottavio
authors.initials: O
authors.lastname: Alfieri
mesh_terms: D002114:Calcinosis / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000379:methods; D015150:Echocardiography, Doppler; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors