Continued follow-up of the free margin running suture technique for mitral repair

Abstract

OBJECTIVES The free margin running suture (FMRS) technique was recently proposed to treat complex degenerative mitral lesions. Limited follow-up data are available. We evaluated the midterm reliability of this technique and the associated mitral valve parameters using rest/stress echocardiography. METHODS One-hundred-eight consecutive patients at 2 European centres were included. Prospective follow-up was performed (266.1 patient-years, average duration 2.5 ± 2.5 years). Echocardiographic scans at rest were obtained for all patients at hospital discharge and at follow-up. Stress echocardiography was also performed in 17 patients. RESULTS There were no operative deaths. FMRS was performed through a right minithoracotomy in 86.1% of patients, with a robotic-assisted technique in 5.6% and through a sternotomy in 8.3%. Bileaflet disease was noted in 31.4%. One patient (0.9%) presented a 2+/4+ residual mitral regurgitation at discharge; lower-degree or no residual regurgitation was noted in the remaining patients. At the follow-up examination, 1 patient (0.9%) presented with a 2+/4+ mitral regurgitation. Coaptation length at discharge versus that at follow-up was 1.3 ± 0.2 vs 1.3 ± 0.1 cm (P = 0.13); the average transmitral gradient was 4.8 ± 1.5 vs 3.5 ± 0.9 mmHg (P < 0.001). In a subpopulation, follow-up echocardiography indicated that the average transmitral gradient at rest versus that at peak effort was 3.2 ± 0.7 vs 5.1 ± 1.3 mmHg (P < 0.001), with no appearance of significant mitral regurgitation and marginally significant increases in pulmonary artery systolic pressures (P = 0.049). CONCLUSIONS Data indicate effectiveness and reproducibility of FMRS, with stability of valve function at midterm. FMRS was also associated with promising outcomes in diastolic performance both at rest and during exercise.

Evaluation of robotic-assisted mitral surgery in a contemporary experience

“…Mitral repair was performed in all cases; the techniques attributable to the 'Respect' domain have been globally preferred (most frequently, posterior leaflet remodeling through free margin running suture). 11,12 More than one technique could be associated in the same patient depending on the intraoperative findings. A complete annuloplasty ring was implanted in 58 (98.3%) cases; no ring was implanted in 1 instance.…”

“…Table 2 reports the intraoperative details; the posterior leaflet was the site of anatomical defect in most instances (71.2%) with a frequent multisegmental involvement, although the frequency of bileaflet disease was consistent (27.1%). Mitral repair was performed in all cases; the techniques attributable to the ‘Respect’ domain have been globally preferred (most frequently, posterior leaflet remodeling through free margin running suture) 11,12 . More than one technique could be associated in the same patient depending on the intraoperative findings.…”

Impact of COVID-19 in the Age of Computer-Assisted Surgery: Cost and Effectiveness Comparison between Robotic and Minimally Invasive Mitral Valve Surgery in a Single-Center Experience

“…In most patients in both groups, we adopted the "Lavaredo Technique" and the implantation of a complete ring for mitral valve repair. Tis previously described approach [13,14], which briefy consists of free-margin suturing of the mitral leafet, has been shown to be safe and efective at follow-up and has been used indiscriminately in the MIMVS and RMVS [15].…”