Surgical treatment of secondary mitral regurgitation: is repair a reasonable option?

The optimal approach for treating secondary mitral regurgitation (MR) is debated. Since annuloplasty alone has resulted in 30% or more recurrent MR in the mid-term, recent studies suggest mitral valve replacement. However, subvalvular repair strategies as an adjunct to annuloplasty in order to prevent recurrent MR due to ongoing left ventricle (LV) remodeling are becoming increasingly popular. In this study we present short term results of patients with secondary MR who underwent mitral repair using a novel subvalvular repair approach and address the questions whether mitral repair is a reasonable option in these patients.

Ten patients presenting with functional MR underwent ring annuloplasty and a subvalvular approximation of the papillary muscles using a technique where the distance between both papillary muscles was adjusted with a Polytetrafluoroethylene (PTFE) string during the saline test (Ring-Noose-String technique).

Nine of ten patients had none-mild MR while in one patient mild-moderate MR due to ongoing leaflet tethering was diagnosed at discharge. In this patient, insufficient adjustment of the PTFE string is hypothesized as the primary mechanism for suboptimal repair. There were no complications related to the novel surgical technique. No patient died during the follow up period.

The Ring-Noose-String technique provides acceptable repair results in the short term. A longer follow-up is needed to proof its long-term efficacy. Subvalvular techniques such as this may allow a durable repair in patients with secondary MR.