title: Can the edge-to-edge technique provide durable results when used to rescue patients with suboptimal conventional mitral repair?
abstract: OBJECTIVE
  The 'edge-to-edge' technique (EE) can be used as a bailout procedure in case of a suboptimal result of conventional mitral valve (MV) repair. The aim of this study was to assess the long-term outcomes of this technique used as a rescue procedure.
  
  
  METHODS
  From 1998 to 2011, of 3861 patients submitted to conventional MV repair for pure mitral regurgitation (MR), 43 (1.1%) underwent a rescue edge-to-edge repair for significant residual MR at the intraoperative hydrodynamic test or at the intraoperative transoesophageal echocardiography. Residual MR was due to residual prolapse in 30 (69.7%) patients, systolic anterior motion in 12 (27.9%) and post-endocarditis leaflet erosion in 1 (2.3%). According to the location of the regurgitant jet, the edge-to-edge suture was performed centrally (60.5%) or in correspondence with the anterior or posterior commissure (39.5%). The original repair was left in place.
  
  
  RESULTS
  There were no hospital deaths. Additional cross-clamp time was 15.2 ± 5.6 min. At hospital discharge, all patients showed no or mild MR and no mitral stenosis. Clinical and echocardiographic follow-up was 97.6% complete (median length 5.7 years, up to 14.6 years). At 10 years, actuarial survival was 89 ± 7.4% and freedom from cardiac death 100%. Freedom from reoperation and freedom from MR ≥ 3+ at 10 years were both 96.9 ± 2.9%. At the last echocardiogram, MR was absent or mild in 37 patients (88%), moderate in 4 (9.5%) and severe in 1 (2.4%). No predictors for recurrence of MR ≥ 2+ were identified. The mean MV area and gradient were 2.8 ± 0.6 cm(2) and 2.7 ± 0.9 mmHg. NYHA I-II was documented in all cases.
  
  
  CONCLUSIONS
  A 'rescue' EE can be a rapid and effective option in case of suboptimal result of 'conventional' MV repair. Long-term durability of the repair is not compromised.
authors: Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy. michele.debonis@hsr.it
authors: Michele
authors: M
authors: De Bonis
authors: Elisabetta
authors: E
authors: Lapenna
authors: Nicola
authors: N
authors: Buzzatti
authors: Maurizio
authors: M
authors: Taramasso
authors: Maria Chiara
authors: MC
authors: Calabrese
authors: Teodora
authors: T
authors: Nisi
authors: Federico
authors: F
authors: Pappalardo
authors: Ottavio
authors: O
authors: Alfieri
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods* / Q000401:mortality / Q000706:statistics & numerical data; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Edge-to-edge technique; Mitral regurgitation; Mitral valve repair