Effect of Edge-to-Edge-Repair on Annulus Tension of Prolapsed Mitral Valve

The edge-to-edge repair (ETER) technique is a mitral valve (MV) repair procedure. It approximates the leading edges of the mitral leaflets by use of sutures, exhibits promising predictable repair results and offers the advantage of being performed pericutaneously without the need for open heart surgery. The technique is becoming a popular surgical procedure to correct MV prolapse caused by abnormal chordal elongation. MV prolapse leads to mitral regurgitation (MR). Generally the ETER technique is performed as a secondary procedure to ring annuloplasty. Although some groups have performed ETER without the ring annuloplasty, recent studies have shown that ETER technique alone leads to substandard results [1]. It is necessary to define the MV annulus mechanics in ETER condition during valve closure or mid-systole as it directly affects the annulus tension (AT) in the annulus plane. AT in the annulus plane is an important force component which balances the myocardium force and contributes to maintaining the annulus shape and size. This AT change caused by the ETER can lead to annulus dilation, reoccurrence of MR and impact reintervention. The objective of the current study is to understand this AT change in the MV annulus tension during the mid-systole in the ETER condition in order to improve the long term efficacy of the ETER procedure on MV annulus tension, after the technique has been applied with both anterior leaflet prolapse and posterior leaflet prolapse.