Introduction
Mitral valve repair (MVr) is recognized as being the best treatment for
severe mitral regurgitation, especially when degenerative[1] . Since the beginning of MVr, many options have been
advocated. From the wide quadrangular resection by Carpentier to the
triangular resection by the Mayo Clinic. Overall, the general trend is
to resect, but less than previously - to avoid tension and not to
plicate the annulus. Then came the option of not resecting at all, as
opposed to resecting. It is sometimes obvious that in dystrophic mitral
regurgitation with a thin ruptured chord no resection can be a good
option as there is no excess tissue. On the contrary, a typical Barlow
shows excess tissue, and even coexisting areas with prolapsed tissue and
billowing tissue with no prolapse. MVr should not follow any dogma, but
just make sense. The aim of any repair is to achieve a good surface of
coaptation, with the smoothest surface possible. Coaptation height
should be assessed in every repair at the end after weaning from by-pass
as it is a key issue for long term durability.
« Resect or respect » concepts are not in opposition: they just do not
apply to the same patients. Those who favor the “respect rather than
resect” do resect whenever needed, and those who resect do “resect with
respect” and do not plicate the annulus , which in the real world does
not oppose as much as one would believe, one technique to the other. It
seems also fair to mention that there are few long-term results with
longitudinal follow up beyond 10 years, and that those published refer
if not all to the resection philosophy.