Edge-to-Edge Technique Used as a Bailout for Suboptimal Mitral Repair: long-term results

BACKGROUND: In case of initial sub-optimal mitral valve repair the edge-to-edge (EE) technique has been used as a bail-out procedure. However, the long-term durability of those rescued mitral valves is currently unknown. With this study we aim to evaluate the long term clinical and echocardiographic results of the EE technique used to rescue patients with initial sub-optimal conventional mitral valve repair.

METHODS: A retrospective review of our institutional database was carried on querying for patients who had undergone mitral valve repair with EE used as a bailout procedure. Cumulative Incidence Function using death as competitive event was used to estimate cardiac death and REDO for mitral valve replacement. To describe the time course of MR, we performed a longitudinal analysis using generalized estimating equations with random intercept for correlated data.

RESULTS: 81 patients were selected. The median follow-up was 9.1 years [IQR 6.7-12.1], maximum: 22.6 years. At 15 years the estimated Kaplan-Meier overall survival was 63.2 ± 8.69%, 95% CI [43.76-77.46] and the predicted rate of moderate to severe MR recurrence was 16.67%. At 15 years the CIF for REDO for mitral valve replacement with death as competing event was 2.5 %; 95% CI [0.48-7.84] No case of more than mild mitral stenosis was detected.

CONCLUSIONS: The EE technique can be effectively used as a bailout procedure in patients with sub-optimal conventional mitral valve repair with very satisfactory long term results.