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Updated: Sep 11, 2025

Fully Endoscopic Mitral Valve Repair with Percutaneous Cannulation of Groin Vessels
Published on: May 26, 2023
Free Margin Running Suture Repair for Bileaflet Mitral Valve Prolapse in Patients with Left Ventricular Dysfunction:
Agnino Alfonso1, Antonio D'Errico Ramirez2, Matteo Parrinello1
1Division of Robotic and Minimally Invasive Cardiac Surgery, HUMANITAS Gavazzeni-Castelli, Bergamo, 24125, Italy.
Objectives:
Repairing severe mitral regurgitation (MR) in patients with degenerative bileaflet prolapse and reduced left ventricular ejection fraction (LVrEF) is challenging. The Free Margin Running Suture (FMRS) technique offers a non-resectional approach, but mid-term data are limited.
Methods:
We analysed 28 patients with bileaflet degenerative MR and LVrEF (≤40%) undergoing FMRS. Primary outcomes were mid-term survival and MR recurrence; secondary outcomes included LVEF, in-hospital complications, transmitral gradient, coaptation length, and mitral valve orifice area.
Results:
Mean age was 59.3 ± 12.8 years; 69.4% were male. No perioperative deaths; 1 patient required ECMO. Mean aortic cross-clamp time was 47 ± 18.6 min. Over 4.7 years, survival was 100%, with 1 case of moderate MR recurrence. At follow-up, LVEF improved to 43.04 ± 2.26 (P < 0.001), and all patients were NYHA I-II.
Conclusions:
FMRS is a minimally invasive, reproducible technique providing durable repair, symptomatic improvement, and excellent mid-term survival.
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