Letter:
To the Editor,
”Mitral valve repair with the edge‐to‐edge technique: A 20 years
single‐center experience” by Konstantinos Sideris et
al.1 provided remarkable information regarding the
surgical intervention of mitral valve defects by illuminating its
essential components. In-depth details support the article as a result
of the authors’ pronounced knowledge of their respective disciplines.
Transcatheter Mitral Valve Repair utilizing the Edge-to-Edge MitraClip
is a modern, minimally invasive therapy of equal significance, despite
the fact that open surgical surgery is emphasized in this paper. This
alternative approach, a closed heart surgery, reduces the chance of
postoperative infection, hence reducing the iatrogenic danger.
Consequently, we believe that the study should have included a
percutaneous intervention comparison model.2
In addition, it was also observed that the article’s position regarding
the severity of Barlow’s disease was very ambiguous. The severity of
Barlow’s illness substantially impacts mitral valve structure, which may
necessitate a modified edge-to-edge procedure called ”The Triple Orifice
Technique”.3 However, no attention was discovered
addressing this issue, which we believe would enhance the edge-to-edge
approach experience. Furthermore, the author regarded the edge-to-edge
technique by Alfieri et al.4 as the preferred
procedure for bi-leaflet and anterior leaflet prolapse, but somehow
failed to reveal a procedure for posterior leaflet prolapse, despite the
inclusion of patients with posterior leaflet prolapse in this study.
Respect rather than resect (RRR) has been identified as an appropriate
method for posterior leaflet prolapse, hence reducing the likelihood of
reoperation.4 Therefore, we believe that postoperative
treatment and rehabilitation should be incorporated into surgical
approaches to lessen the possibility of reoperations. Nonetheless,
neither rehabilitation nor antithrombotic management were
mentioned.5 Lastly, the investigation revealed that
the cause of death for 19 patients could not be determined, although
cardiac causes were identified in 40% of the evaluated deaths. Which
statement would have been crucial in determining the postoperative
treatment issues.1
As each of the aforementioned factors adds to the foundation of the
study that elucidates the edge-to-edge technique in considerable depth,
we feel that focusing on these factors could enhance the retrospective
analysis of the event. In individuals with end-stage DCM, MV repair is
feasible, with a low inpatient mortality rate and significant relief in
symptoms. The combination of the edge-to-edge approach and undersized
annuloplasty can considerably enhance the longevity of the
repair.4 Left ventricular (LV) failure is often
accompanied with functional mitral regurgitation in ischemic or
idiopathic dilated cardiomyopathy (DCM) (FMR). FMR has been treated
using undersized ring annuloplasty. However, mitral insufficiency can
return in a substantial number of patients. Patients with mild to
moderate annular dilatation, significant tethering, and complex jets
appear to be particularly unreliable candidates for this type of
surgery. However, the majority of unfavorable outcomes have been
reported when the edge-to-edge approach has been utilized without
simultaneous annuloplasty or in conjunction with only a posterior
flexible band, neither of which could prevent the advancement of annular
dilatation in the presence of DCM.5