Letter to Editor: Mitral valve surgery; from median sternotomy to closed chest procedures, from replacement to repair techniques/Clinical outcomes of mitral valve repair in mitral regurgitation: a prospective analysis of 100 consecutive patients

Closed commissurotomy technique is the first surgical mitral valve (MV) treatment of severe mitral stenosis pioneered by Cutler and Levine followed by Souttar in 1923 (1, 2), further refined by Harken and Bailey (3) which offered more predictable outcomes. With the development of the heart-lung machine in 1953, direct access to the MV was possible, commissurotomy could then be performed under direct controlled vision through a left or right atriotomy. The first MV replacement was performed in 1961 by Starr et al. (4). Although valve replacement rapidly became popular, surgeons encountered complications with prosthetic valve replacement and this led them to investigate further techniques to repair the MV. The establishment of a physiologic classification of the MV by Carpentier in the 1970s allowed a comprehensive approach to its repair (5). Further development in prosthetic rings ensured reproducible and durable repair rates among centers. With refinements in operative techniques including cardiopulmonary bypass (CPB) circuits as well as perioperative care, mitral repair surgery through a sternal approach is now performed with mortality rates ranging from 1 to 4% with minimal morbidity. Furthermore, freedom from reoperation after mitral repair is excellent, especially when the disease is localized to the posterior leaflet and the postoperative echocardiog- raphy shows minimal residual mitral regurgitation.