Invited Commentary

Abstract

In the 1960s, Kay and colleagues [1Kay J.H. Egerton W.S. Zubiate P. The surgical treatment of mitral insufficiency and combined mitral stenosis and insufficiency with use of the heart-lung machine.Surgery. 1961; 50: 67-74PubMed Google Scholar] and Reed and colleagues [2Reed G.E. Tice D.A. Clauss R.H. Asymmetric exaggerated mitral annuloplasty: repair of mitral insufficiency with hemodynamic predictability.J Thorac Cardiovasc Surg. 1965; 49: 752-761PubMed Google Scholar] described methods to reduce the posterior annulus by plicating the annulus at the commissures. Anchoring sutures were placed on the anterior side of the annulus at the commissure, with considerably larger bites on the posterior annulus, which decreased the length of the posterior annulus. By contrast, annuloplasty is used to support or reduce in size the posterior portion of the mitral annulus and to provide a stable foundation for appropriate alignment of the leaflets. Some surgeons use the Kay suture plication technique only if abnormalities are localized solely at the commissures, which are not the majority of cases. Also, Kay and colleagues demonstrated good results with mitral repair for patients with ischemic mitral insufficiency, but no analyses were performed to examine the impact of confounding variables. Some studies demonstrated that complications after mitral valve repair, including annuloplasty, were affected by patients' preexisting comorbidities [3Grossi E.A. Goldberg J.D. LaPietra A. et al.Ischemic mitral valve reconstruction and replacement: comparison of long-term survival and complications.J Thorac Cardiovasc Surg. 2001; 122: 1107-1124Abstract Full Text Full Text PDF PubMed Scopus (279) Google Scholar]. Sawazaki and colleagues [4Sawazaki M. Tomari S. Izawa N. Zaikokuji K. Tateishi N. Imaeda Y. Interrupted commissural band annuloplasty for degenerative mitral valve disease.Ann Thorac Surg. 2014; 97: 558-562Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar] modified the original Kay technique in order to avoid posterior annuloplasty to prevent hemolysis and prevent mitral stenosis secondary to pannus formation. The article by Sawazaki and colleagues [4Sawazaki M. Tomari S. Izawa N. Zaikokuji K. Tateishi N. Imaeda Y. Interrupted commissural band annuloplasty for degenerative mitral valve disease.Ann Thorac Surg. 2014; 97: 558-562Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar] reports a series of 63 patients with bilateral commissural band annuloplasty compared with 58 patients with a Cosgrove band, looking at the incidence of mitral stenosis and hemolysis that seems to favor the former technique. The incidence of these complications is generally low, and the attempt at improving the technique of Kay and colleagues does not seem to address prime considerations in the occidental setting of mitral valve repair. Definitive conclusions regarding the use of this technique can be derived only after a larger comparative study and by including numerous precisions on types of lesions, patients' preoperative characteristics, and associated procedures. Finally, on the basis of long-term studies, mitral valve repair at 10 years is durable, meaning that is carries better survival than do mechanical valves [4Sawazaki M. Tomari S. Izawa N. Zaikokuji K. Tateishi N. Imaeda Y. Interrupted commissural band annuloplasty for degenerative mitral valve disease.Ann Thorac Surg. 2014; 97: 558-562Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar, 5DiBardino D.J. ElBardissi A.W. McClure R.S. Razo-Vasquez O.A. Kelly N.E. Cohn L.H. Four decades of experience with mitral valve repair: analysis of differential indications, technical evolution, and long-term outcome.J Thorac Cardiovasc Surg. 2010; 139 (discussion 83–74): 76-83Abstract Full Text Full Text PDF PubMed Scopus (102) Google Scholar]. Also, repair offers a better preservation of heart function, lower risk of thromboembolic events, and infection, and it does not require the use of anticoagulation. In the near future, the technique presented in this article could be added to the available methods of performing mitral repair. Interrupted Commissural Band Annuloplasty for Degenerative Mitral Valve DiseaseThe Annals of Thoracic SurgeryVol. 97Issue 2PreviewMitral annuloplasty is useful for treating degenerative mitral valve disease. Although the incidence of complications is low, prosthetic ring-related complications can occur. Hemolysis and mitral stenosis are serious complications requiring reoperation. Limited use of prosthetic material could decrease the risk for complications. Commissural annuloplasty has been reported by Kay and Reed; their techniques involve suture plication. To prevent dehiscence, we selected short bands and compared the echocardiographic changes between this method and the Cosgrove ring. Full-Text PDF