title: Edge-to-edge repair for prevention and treatment of mitral valve systolic anterior motion.
abstract: BACKGROUND
  The edge-to-edge technique has been proposed to prevent systolic anterior motion (SAM) of the mitral valve. There is limited clinical data available on outcomes of this technique for this indication. We reviewed the midterm results of this technique for SAM prevention and treatment.
  
  
  METHODS
  A total of 2226 patients had mitral valve repair between 2000 and 2011, 1148 of which were for myxomatous mitral regurgitation. Beginning in 2000, predictability of postrepair SAM based on the prebypass, intraoperative transesophageal echocardiogram arose in our program. The edge-to-edge technique was used in 65 patients (5.7%) for SAM management, in 53 patients preemptively for transesophageal echocardiogram-based SAM prediction, and in 12 patients for postrepair SAM treatment.
  
  
  RESULTS
  There was no operative mortality. Postoperative mitral regurgitation was significantly improved in all patients compared with the preoperative grade (P < .001). SAM was completely eliminated, the mean mitral regurgitation grade in the postoperative period was 0.7 ± 0.9, and the mean transmitral gradient was 1.3 ± 2.2 mm Hg. During a mean follow-up of 26 months, 1 patient in the SAM treatment group presented late recurrence of SAM and no patients developed mitral stenosis (mean transmitral gradient, 2.0 ± 2.6 mm Hg; P = .12). Without SAM prediction and preemptive edge-to-edge technique, the expected rate of SAM would have been 5.7%; however, the observed rate was 1% (12 of 1148 patients).
  
  
  CONCLUSIONS
  Initiating an expectation for prebypass SAM prediction, combined with a surgical SAM prevention strategy, resulted in a reduced prevalence of SAM compared with our model of observed to-expected-ratios and to published norms.
authors.affiliation: Division of Cardiac Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, Mass.
authors.forename: Patrick O
authors.initials: PO
authors.lastname: Myers
authors.forename: Zain
authors.initials: Z
authors.lastname: Khalpey
authors.forename: Ann M
authors.initials: AM
authors.lastname: Maloney
authors.forename: Derek R
authors.initials: DR
authors.lastname: Brinster
authors.forename: Michael N
authors.initials: MN
authors.lastname: D'Ambra
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Cohn
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D017548:Echocardiography, Transesophageal; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000209:etiology / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013536:Suture Techniques; D013997:Time Factors; D016896:Treatment Outcome