INTRODUCTION
With an estimated prevalence varying from 2% to 3% in the general population and a wide range of causes, clinical features, and complications, mitral valve prolapse presents with a marked heterogeneity of symptoms and clinical findings; when associated with mitral regurgitation, combined with symptoms and/or left ventricular dilatation and impairment, it often represents a surgical challenge. Surgical repair is universally accepted as the “gold standard” therapy of mitral disease, anyhow the technical landscape of mitral repair is overfilled by the contribution of decade’s long experiences and refinements. In this scenario, choosing the correct repair strategy becomes indeed a challenge itself.
Historically, 2 distinct surgical approaches have developed in mitral valve repair: the “Resect” approach, which focuses on resection techniques involving triangular or quadrangular excisions of excess valvular tissue, and the “Respect” approach, which emphasizes leaflet preservation through the use of single or multiple artificial chordae tendineae. Both strategies, typically combined with annuloplasty, have proven effective in achieving durable and efficient coaptation between the anterior and posterior mitral leaflets.
Since the description of a novel set of techniques by Kofidis, we embraced this philosophy at our institution, thus resulting in a shift from a resection-only strategy towards an approach which encompass the resuspension of the prolapsing leaflet with a single running suture. The underlying concept of Kofidis’s techniques is the standardization of the procedure, reduction of variability, and guesswork elimination, by following a pattern, rather than variable moves and many individual cords.
Compared to conventional repair strategies, which often rely on multiple, technically demanding manoeuvers such as triangular or quadrangular resection, the Roman Arch technique may offer important practical advantages. Its design favours standardization and highly reproducibility, and it is potentially applicable to prolapse involving any mitral leaflet segment. Moreover, the simplicity of the single running suture may facilitate a potentially shorter learning curve, making the approach appealing for both experienced surgeons and those in training. Additionally, the use of standard materials may contribute to favourable cost-effectiveness, further supporting its integration into surgical practice.
We, therefore, sought to report the early outcomes of this new repair philosophy in a consecutive cohort of patients with severe mitral regurgitation.