Midterm results of edge-to-edge mitral valve repair without annuloplasty

Objective: Edge-to-edge mitral valve repair is usually performed in association with annuloplasty, with rare exceptions. We retrospectively analyzed the results of ringless edge-to-edge repair, particularly in view of minimally invasive and percutaneous approaches. Methods: From November 1993 to December 2001, 81 patients underwent edge-to-edge mitral repair without associated annuloplasty. The cause was degenerative in most patients. In 32 patients the annulus was severely calcified. Type I lesions were present in 6 patients, type II lesions in 60 patients, and type III lesions in 15 patients. A double-orifice repair was done in 69 patients, and paracommissural repair was done in 12 patients. In 5 patients edge-to-edge repair was used as a rescue procedure. Results: There were 3 hospital and 4 late deaths, for a 4-year survival of 85%+/-16.7%. At latest follow-up, 63 patients were in New York Heart Association classes I or 11, and 9 patients were in classes III or IV. Nine patients required reoperation (89%+/-3.9% overall freedom from reoperation at 4 years). Annular calcification was associated with a greater reoperation rate (77%+/-22% vs 95%+/-4.6% freedom from reoperation, P=.03). Intraoperative water testing and postrepair transesophageal echocardiography predicted late failure. Only 1 of 42 patients required reoperation in the follow-up period when annular calcification, rheumatic disease, or rescue procedure were not present as risk factors. Conclusions: Our data confirm overall suboptimal results of the edge-to-edge technique when annuloplasty is not added to the repair. Annular calcification, rheumatic cause, and edge-to-edge repair done as a rescue procedure were associated with the worst outcome. Midterm results in selected patients encourage future developments in catheter-based edge-to-edge procedures.