The great performance of the edge-to-edge repair in the anterior leaflet prolapse: a surprise?

Abstract

In the meta-analysis of Khairallah et al. [1], 2 surgical techniques (the edge-to-edge repair and the neochordal repair) to correct mitral regurgitation (MR) due to isolated anterior leaflet prolapse are compared. A relevant finding is that a lower incidence of recurrent MR was observed in the follow-up when the lesion was corrected using the edge-to-edge repair. The first edge-to-edge mitral valve repair was carried out by us about 30 years ago in a patient with severe MR due to an isolated anterior leaflet prolapse. The functional result was perfect: the newly created double-orifice mitral valve was totally competent, and the global mitral valve area after implantation of a prosthetic ring was well above 3 cm2. At that time (early 1990s), the overall mitral valve repair rate in the surgical community was rather low, particularly in some subsets of lesions due to the complexity and/or ineffectiveness of the available surgical techniques. Triangular resection, chordal transposition and chordal shortening for anterior leaflet prolapse were not uncommonly associated with haemodynamically significant residual or recurrent MR and suboptimal results, even in experienced hands, were repeatedly reported [2–5]. On the contrary, the prolapse of the posterior leaflet, by far the most common lesion in degenerative MR, already at that time was associated with very satisfactory short- and long-term outcomes.