The Early Phase of Clinical Application: Lessons Learned

The experience of mitral valve repair (MVR) in the presence of anterior or bileaflet involvement has been not as satisfactory as the results of valve reconstruction for isolated posterior leaflet dysfunction [1–4]. Indeed, whereas quadrangular resection or other reparative techniques have been widely applied with remarkable long-lasting effects [5], mitral valve insufficiency (MVI) caused by mechanisms other than isolated posterior leaflet prolapse has been associated with more complex and time-consuming repair methods and has been characterized by higher rates of recurrent MVI [1–4]. The “French correction” proposed by Carpentier certainly provided major breakthroughs for reconstructing the mitral valve in the presence of variable patterns of MVI [6], but postoperative results were indisputably less favorable for specific MVI settings like anterior, bileaflet, or commissural lesions [1–4]. Under these circumstances, the traditional repair techniques proposed were more complex and often not easily reproducible. More expeditious and reliable techniques were advocated by the surgical community to overcome the above mentioned drawbacks in the treatment of MVI. The edge-to-edge (EE) technique was therefore designed to provide a simple, quick, and reproducible procedure meant to restore durable mitral leaflet coaptation in several MVI patterns, but, particularly, to counteract anterior, bileaflet, or commissural-based prolapse and MV regurgitation [7].