THE EDGE-TO-EDGE TECHNIQUE - A SIMPLIFIED METHOD TO CORRECT MITRAL-INSUFFICIENCY

Objective: Repair of mitral regurgitation (MR) is more demanding in ca se of prolapse of the anterior leaflet, posterior leaflet with calcifi ed annulus, or prolapse of both leaflets. We evaluated a repair which consists of anchoring the free edge of the prolapsing leaflet to the c orresponding free edge of the facing leaflet: the 'edge-to-edge' (E-to -E) technique. The correction results in a double orifice valve when t he prolapse is in the middle portion of the leaflet and in a smaller v alve orifice when the prolapse is close to a commissure. Methods: Out of 432 patients with MR submitted to valve repair between January 1991 and September 1997, 121 (mean age 56 +/- 15.8 years) underwent E-to-E correction. The most prevalent etiology was degenerative disease (82 patients, 68%). The mechanism of MR was anterior leaflet prolapse (61 patients), posterior leaflet prolapse (24 patients), prolapse of both leaflets (28 patients) and other complex mechanisms (8 patients). In 7 2 patients, a double orifice was created, the paracommissural repair w as done in 49 patients. Results: Hospital mortality was 1.6%. Overall survival was 92 +/- 3.1% at 6 years with 95 +/- 4.8% freedom from reop eration. Mortality was unrelated to the type of repair. Mitral stenosi s was never observed after the correction. At the follow-up (mean 2.2 +/- 1.5 years), all patients but 15 are class I or II. Symptoms at the follow-up are not related to residual MR. Conclusions: Midterm result s of this alternative repair technique are promising, considering the high prevalence of complex anatomical lesions. The technique is simple . easily reproducible and rapidly feasible also when mitral exposure i s suboptimal. (C) 1998 Elsevier Science B.V. All rights reserved.