ABSTRACT
The edge-to-edge (E2E) technique was introduced in the surgical armamentarium of mitral valve repair in the early 1990s and has been used progressively to restore mitral competence in the setting of degenerative, functional and, occasionally, postendocarditis mitral regurgitation (MR) (1,2). While the aim of traditional mitral repair techniques is to realize an anatomical reconstruction of the diseased valve, the original idea behind the E2E approach is that the competence of a regurgitant mitral valve can be effectively restored with a “functional” rather than an anatomical repair. Indeed, the key point of this surgical method is to identify by preoperative transesophageal echocardiography the precise location of the regurgitant jet. Exactly at that level, the free edge of the diseased leafl et is sutured to the corresponding edge of the opposing leafl et thereby eliminating mitral incompetence. When the regurgitant jet is in the central part of the mitral valve, the application of the E2E technique produces a mitral valve with a double-orifi ce confi guration (double-orifi ce repair) (Fig. 3.1). Depending on the extension and location of the suture performed, the two orifi ces can have similar or different sizes. In case of commissural prolapse or fl ail, on the other hand, the jet of regurgitation is usually identifi ed in correspondence with the commissural area and the application of the E2E technique leads to a surgical closure of the commissure (“paracommissural edge-to-edge repair”). Under these circumstances, the mitral valve will have a single orifi ce with a relatively smaller area compared with the preoperative value (Fig.3. 2).
