The Wishful Thinking of Indirect Mitral Annuloplasty

During the past 3 decades, there have been major advances in our understanding of mitral valve function and its pathophysiology. This has led to the development of very creative and effective surgical techniques for the repair of the mitral valve.Article see p 277 Currently, the clinical benefits of mitral regurgitation treatment by surgical mitral valve repair techniques are similar to those of mitral valve replacement. However, mortality is significantly lower after mitral valve repair than after valve replacement (0.2% versus 2.1%, P =0.001).1 Reoperation after mitral valve repair is rare (4.7%). Half of the small number of patients who require reoperation for valve-related problems undergo reoperation within 19 days of the original surgery. Of all reoperations, late reoperation occurs in 58%, at a median of 5.4 years. Mitral valve replacement was performed in 64% of all reoperations. Ten years after the second operation, the incidence of a third surgery was 7%.2 Despite these good results, mitral repair is performed in less than one third of the US patients undergoing mitral valve surgery.3,4The surgical experience with mitral valve repair has shown that to achieve a successful and lasting result, mitral annuloplasty is required; this is especially true for repair of functional mitral regurgitation. Choosing the correct size and shape of the mitral annulus ring to be used for any …