Mitral valve repair in complex anatomy and challenging patients: the versatility of the edge to edge concept

Heart, Lung and Vessels. 2013, Vol. 5 The edge-to-edge technique was introduced into the surgical armamentarium of mitral valve repair in the early 1990s and, from the beginning, it appeared to be an attractive approach because of its simplicity, reproducibility and effectiveness even in complex settings (1-3). The technique is used to treat both organic and functional mitral regurgitation (MR). The surgical repair consists of the suture of the free edge of the leaflets at the site of regurgitation, creating a valve with 2 orifices when the regurgitation originates from the middle scallops. As opposed to conventional techniques, MR is corrected by obliteration of the regurgitant orifice at the leaflet level, regardless the anatomical lesion. This concept implies that the same technique can be applied to different anatomical and functional conditions (1-5). We predicted many years ago, that the edge to edge repair, due to its simplicity and versatility, could open the perspective of percutaneous correction of MR (3). In the last years, the prediction became reality, and nowadays the edge to edge concept is the basis of the MitraClip therapy, which represents currently most widespread and successful catheter-based method of correcting MR. The value of the technique has been long debated in the surgical arena, initially with several detractors, mainly because of the perceived non-physiological consequences. Currently, the technique has been demonstrated safe, effective, and durable and several institutions around the world adopted this surgical method in selected patients with MR due to different causes and mechanisms (6-10). The current indications and major contraindications for the edgeto-edge repair are mainly based on the surgical results obtained with E di to ri al Mitral valve repair in complex anatomy and challenging patients: the versatility of the edge to edge concept