Interscallop indentation closure as an adjunctive technique in mitral valve repair for degenerative mitral valve disease

Background Interscallop indentation closure is a useful adjunctive technique which presents several different effects in repairing degenerative mitral regurgitation. However, there are some concerns that it might reduce mitral valve area by restricting the posterior leaflet mobility. We aim to assess postoperative echocardiographic findings after mitral valve repair using this technique. Methods Between January 2009 and December 2015, 897 patients underwent mitral valve repair for degenerative mitral regurgitation at our institutions. We reviewed 98 patients in which we used indentation closure technique, and we analyzed operative and echocardiographic data. Results Ring annuloplasty and concomitant repair techniques such as leaflet resection and neochordal placement were used in all patients. Specific purposes of indentation closure included gap closure (n = 57), prolapse repair (n = 11), leaflet redundancy repair (n = 16), and leaflet deficiency repair (n = 12). Eleven patients had double indentation closure. Postoperative pre-discharge echocardiography showed no moderate or greater residual mitral regurgitation, mean transmitral pressure gradient of 3.4 +/- 1.4 mmHg, and mitral valve area of 2.7 +/- 0.7 cm(2). Follow-up echocardiography performed at 43.7 +/- 23.9 months after surgery showed six cases (6.4%) with recurrent moderate or greater mitral regurgitation, mean transmitral pressure gradient of 3.3 +/- 1.3 mmHg, and mitral valve area of 2.5 +/- 0.6 cm(2). Conclusions Interscallop indentation closure is a simple and effective adjunctive technique which can be used for several different purposes. It achieves excellent control of mitral regurgitation with preserved mitral valve area when it is used in addition to standard mitral valve repair techniques in selected cases.