Journal Article

Free Margin Running Suture Repair for Bileaflet Mitral Valve Prolapse in Patients with Left Ventricular Dysfunction: A Mid-term Follow-up Study

Agnino, Alfonso, Parrinello, Matteo, Muccio, Salvatore, Ruggieri, Vito Giovanni, D’Errico Ramirez, Antonio, Anselmi, Amedeo

2025

Overview

Abstract Objectives Repairing severe mitral regurgitation (MR) in patients with degenerative bileaflet prolapse and reduced left ventricular ejection fraction (LVrEF) is challenging. The Free Margin Running Suture (FMRS) technique offers a non-resectional approach, but mid-term data are limited. Methods We analysed 28 patients with bileaflet degenerative MR and LVrEF (≤40%) undergoing FMRS. Primary outcomes were mid-term survival and MR recurrence; secondary outcomes included LVEF, in-hospital complications, transmitral gradient, coaptation length, and mitral valve orifice area. Results Mean age was 59.3 ± 12.8 years; 69.4% were male. No perioperative deaths; 1 patient required ECMO. Mean aortic cross-clamp time was 47 ± 18.6 min. Over 4.7 years, survival was 100%, with 1 case of moderate MR recurrence. At follow-up, LVEF improved to 43.04 ± 2.26 (P < 0.001), and all patients were NYHA I-II. Conclusions FMRS is a minimally invasive, reproducible technique providing durable repair, symptomatic improvement, and excellent mid-term survival. Mitral valve (MV) repair is the surgical intervention of first choice in degenerative primary mitral regurgitation (MR). Graphical Abstract

• Publisher: Oxford University Press,Oxford Publishing Limited (England)
• Subject: Aged / Cardiology and cardiovascular system / Ejection fraction / Female / Follow-Up Studies / Heart surgery / Hospitals / Human health and pathology / Humans / Hypothesis testing / Interdisciplinary aspects / Life Sciences / Male / Middle Aged / Mitral Valve - diagnostic imaging / Mitral Valve - physiopathology / Mitral Valve - surgery / Mitral Valve Annuloplasty - adverse effects / Mitral Valve Annuloplasty - mortality / Mitral Valve Insufficiency - diagnostic imaging / Mitral Valve Insufficiency - mortality / Mitral Valve Insufficiency - physiopathology / Mitral Valve Insufficiency - surgery / Mitral valve prolapse / Mitral Valve Prolapse - complications / Mitral Valve Prolapse - diagnostic imaging / Mitral Valve Prolapse - mortality / Mitral Valve Prolapse - physiopathology / Mitral Valve Prolapse - surgery / Mortality / Ostomy / Patients / Recovery of Function / Recurrence / Retrospective Studies / Robotic surgery / Stroke Volume / Suture Techniques - adverse effects / Suture Techniques - mortality / Thoracic surgery / Time Factors / Treatment Outcome / Valvular Heart Disease / Ventricular Dysfunction, Left - complications / Ventricular Dysfunction, Left - diagnosis / Ventricular Dysfunction, Left - diagnostic imaging / Ventricular Dysfunction, Left - mortality / Ventricular Dysfunction, Left - physiopathology / Ventricular Function, Left