RF18 EDGE TO EDGE PROCEDURE AS AN ALTERNATIVE TO QUADRANGOLAR RESECTION OF ISOLATED PROLAPSE OF POSTERIOR MITRAL LEAFLET

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Backgruond and Aim: We present our casuistry links to prolapse/flail of P2 LPM in mitral regurgitation treated with edge-to-edge technique when contraindicated to quadrangolar resection. We hereby present our experience using a modified edge-to-edge technique to address this peculiar MR. Methods: From January 1999 to January 2015, 89 consecutive patients (mean age 56 ± 14,56, 53 males) affected by prolapse/flail of P2 LPM in mitral regurgitation. Preoperative transesophageal echo (TEE) in all the cases showed prolapse/flail of P2 LPM when it exists a controindication to quadrangolar resection like: extensive resection 52%, posterior anulus calcification 23%, hypertrofic/small ventricle 27%. In all the patients, a doble orifice valve (DOV) repair with annuloplasty was performed. Intra-operative TEE and postoperative transthoracic echocardiography (TTE) were carried out to evaluate results of the DOV repair. Results: There was no in-hospital death. At intra-operative TEE, the two orifices showed a mean total valve area of area 3,06 ± 0,63 cm with no residual regurgitation or trivial and no sign of valve stenosis (Grad med 3,73 ± 1,66; Grad max 11,02 ± 7,48). At follow up (from 1999 to 2015) we appreciated a freedom from reoperation 97%(fig.1) and survival 95% (Fig. 1). Conclusions: We consider edge to edge a valid alternative in pts with prolapse/flail of P2 in LPM when exist: extensive resection that may determinate a residual mitral regurgitation by LPM retraction, posterior anulus calcification that may determinate no possibility of annular plication and hypertrofic/small ventricle for high risk of persistent SAM.

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