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Ilir Hysi, Olivier Fabre, One-year results of beating heart mitral repair: where do we set the limit?, European Journal of Cardio-Thoracic Surgery, Volume 60, Issue 4, October 2021, Page 1003, https://doi.org/10.1093/ejcts/ezab106
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We read with great interest the article from Gammie et al. [1] reporting 1-year results in patients treated with the HARPOON System. These were highly selected, very low-risk patients presenting with isolated P2 prolapse mitral regurgitation (MR). Among 62 patients, who achieved technical success, there was no death or stroke. At discharge, 3% of the patients had a moderate MR and 2% a severe one. At 30 days, 13% and 2% of the patients had a moderate and severe MR, respectively. At 1 year, 23% and 2% of the patients had a moderate and severe MR, respectively, and 13% required reoperations. Although these, ‘mixed results’, the authors conclude confidently that they are encouraging.
In our opinion, this statement is not supported by the data and raises the question: in 2021, where do we put the threshold of satisfactory results for isolated P2 prolapse mitral repair (which has the highest rate of repair) in low-risk patients?
Johnston et al. [2] put the landmarks of posterior mitral prolapse repair with an operative mortality of 0.07% and a freedom from mitral reoperation (FMR) of 97% at 10 years. This was also confirmed by many groups. Axtell et al. [3] had a 100% FMR at 3 years, our group [4] had a 91.7% FMR at 4 years and the Leipzig group [5] with a solid experience in 2134 minimally invasive patients had a 97% FMR at 1 year.
To avoid a CPB, can we accept, in low-risk patients, inferior results of mitral repair than the results already achieved by minimally invasive surgery?
Conflict of interest: none declared.
