Respect versus resect approaches for mitral valve repair: A study-level meta-analysis

Michel Pompeu Sá, Luiz Rafael P. Cavalcanti, Jef Van den Eynde, Andrea Amabile, Antonio C. Escorel Neto, Alvaro M. Perazzo, Alexander Weymann, Arjang Ruhparwar, Serge Sicouri, Gianluigi Bisleri, Gianluca Torregrossa, Arnar Geirsson, Basel Ramlawi

Research output: Contribution to journalReview articlepeer-review

6 Scopus citations


Mitral valve repair (MVr) restores leaflets coaptation while preserving the patient's own valve. The two main techniques are: (a) chordal replacement (“respect approach”), whereby artificial neochordae are used to resuspend prolapsed segments of the affected leaflet – and (b) leaflet resection (“resect approach”), whereby diseased leaflet segment is resected, and the remaining segments are sutured together. Both techniques of MVr are associated with better long-term results, fewer valve-related complications and lower mortality when compared with mitral valve replacement (MVR). They also restore quality of life and improve survival to rates equivalent to those of the general population. We performed a meta-analysis to pool data of clinical studies that compared outcomes of MVr stratified by the surgical technique. Seventeen studies accounting for 6,046 patients fulfilled our eligibility criteria. The “respect approach” outperformed the “resect approach” with lower permanent pacemaker implantation rates and lower mean gradients. Despite any possible advantages of one technique over the other, which approach is best for each patient must be decided on a case-by-case basis and more long-term follow-up data are warranted.

Original languageEnglish
Pages (from-to)225-239
Number of pages15
JournalTrends in Cardiovascular Medicine
Issue number4
StatePublished - May 2023
Externally publishedYes


  • Cardiac Valve Annuloplasty
  • Cardiac surgical procedures
  • Cardiovascular surgical procedures
  • Heart Valve Diseases
  • Heart Valve Prosthesis Implantation
  • Heart Valves
  • Meta-analysis
  • Mitral Valve
  • Mitral Valve Annuloplasty
  • Mitral Valve Insufficiency
  • Mitral Valve Prolapse
  • Mitral valve repair


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