Edge-to-edge surgical mitral valve repair in the era of MitraClip: what if the annuloplasty ring is missed?

Purpose of reviewThe purpose of this review is to define the role of annuloplasty in the surgical edge-to-edge repair, an issue that seems particularly relevant in the current MitraClip era, when more than 15000 patients have been submitted to a percutaneous transcatheter edge-to-edge repair without concomitant annuloplasty.Recent findingsOnly a few studies have reported the clinical and echocardiographic outcomes of the ringless edge-to-edge mitral repair. In all of them, however, only mid-term data were provided. Recently, the long-term results of the surgical edge-to-edge procedure performed without a concomitant annuloplasty in a selected group of patients with degenerative mitral regurgitation have been published.SummaryThe surgical edge-to-edge technique should always be combined with prosthetic ring annuloplasty in order to provide excellent long-term outcomes in patients with degenerative mitral regurgitation. The overall long-term results of the surgical edge-to-edge technique without annuloplasty are not satisfactory. The ringless edge-to-edge technique is not effective in the challenging setting of extensively calcified annulus. In patients without annular calcification, in whom annuloplasty was intentionally avoided, the ringless edge-to-edge repair provides acceptable results in the mid term but is associated with a high failure rate in the long term. In the MitraClip perspective, these findings emphasize the need for a reliable annuloplasty to improve the long-term outcomes of the currently available transcatheter edge-to-edge procedure.