The edge-to-edge technique as a trick to rescue an imperfect mitral valve repair

Objective: The edge-to-edge (E-to-E) technique in mitral valve repair (MVR) is promising especially to correct mitral insufficiency (MI) caused by complex mitral valve lesions. We tested this technique to improve residual MI straight after conventional MVR.

Methods: From September 1998 to January 2002, 108 consecutive patients underwent MVR with current techniques for pure MI. Intraoperative transesophageal echocardiography was performed before and after MVR. At the end of cardiopulmonary bypass (CPB), 11 patients presented residual mitral regurgitant jet area (MRA) > or =2.0 cm(2). The E-to-E technique was used to improve this residual MI, without taking-down the original MVR.

Results: There were no hospital deaths. One patient died of non-valve-related cardiac death about 6 months after hospital discharge. At intraoperative ecocardiography, residual MRA improved from 3.0 +/- 0.8 cm(2), after conventional MVR, to 0.7 +/- 0.9 cm(2), after the E-to-E technique (P = 0.00014). Additional CPB time of 14.9 +/- 2.8 min was needed. These echocardiographic results were confirmed at follow-up of 13.8 +/- 8.1 months.

Conclusions: The E-to-E technique is a simple, rapid, effective, and durable option to reduce residual MI and rescue an imperfect conventional MVR.