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

PURPOSE OF REVIEW: The 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 15 000
patients have been submitted to a percutaneous transcatheter edge-to-edge repair
without concomitant annuloplasty. RECENT FINDINGS: Only 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. SUMMARY: The 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.