Edge-to-edge repair for mitral regurgitation: a clinical and exercise echocardiographic study.
OBJECTIVE
The durability and potential for creating functional mitral stenoses are major concerns in the edge-to-edge (E-to-E) repair of mitral regurgitation (MR).


METHODS
Valve repair for MR was performed using the classical Carpentier technique in 120 patients (group C), and with the E-to-E technique in 37 patients (group E). A ring annuloplasty was performed in all patients. The mid-term results were examined and exercise echocardiography was conducted.


RESULTS
No significant differences were observed between the two groups with regards to early and late mortality rates, actuarial survival rate and valve-related complication-free rate at five years after surgery. Postoperatively, MR was decreased significantly in both groups. Exercise echocardiography was undertaken in 35 operative survivors (20 from group C, 15 from group E). At peak exercise, the mean transmitral pressure gradient (MTPG) increased significantly in both groups. Systolic pulmonary artery pressure (SPAP) was also significantly elevated, but still within the accepted upper limits in both groups. The mitral valve area (MVA) showed no significant increase in either group. At peak exercise there were no significant differences in MTPG, SPAP and MVA between the two groups.


CONCLUSIONS
Edge-to-edge repair is equally effective and durable as a conventional repair using the Carpentier technique. A mitral valve redesigned by E-to-E repair with ring annuloplasty may be slightly restrictive compared to a normal healthy mitral valve under exercise conditions; however, the hemodynamic performance did not differ significantly from that of a valve repaired with the Carpentier technique. These hemodynamics were not related to the use of E-to-E repair per se as the only causal factor, but rather to the ring annuloplasty.
Hori
Hidetsugu
H
Department of Surgery, Kurume University School of Medicine, Kurume, Japan. hideho16@med.kurume-u.ac.jp
Fukunaga
Shuji
S
Arinaga
Koichi
K
Yoshikawa
Kazuhiro
K
Tayama
Eiki
E
Aoyagi
Shigeaki
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D025401:Echocardiography, Stress; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D012189:Retrospective Studies; D015996:Survival Rate; D013536:Suture Techniques