Early Follow-up of Roman Arch Mitral Valve Repair Technique: The Paris Experience

Abstract Objectives Degenerative mitral valve disease presents peculiar surgical challenges in patients presenting with mitral regurgitation. We reviewed the early results of a novel set of techniques to validate the feasibility for patients who underwent mitral valve repair. Methods Between January 2024 and December 2024, 40 patients underwent mitral valve repair using artificial neochordal implantation following the principles of the Roman Arch technique. The original technique was modified in order to treat any mitral prolapse. We retrospectively reviewed the early post-operative clinical outcomes, and follow-up echocardiographic data. Results Successful mitral valve repair was performed in all patients. Mean aortic cross-clamp time was 74 ± 18 min while cardiopulmonary bypass time was 108 ± 23 min. Mitral valve repair techniques consisted of ring annuloplasty and the Roman Arch technique, oftenly adapted to treat multiple prolapsing segments. There were no peri-operative deaths nor there was any 30-day mortality recorded. One patient (2.5%, 95% CI: 0.06%-13.2%) needed mitral valve reintervention due to infective endocarditis occurred at 8 months after the index surgery. During the echocardiographic follow-up (9 ± 3 months) only 2 patients (5%, 95% CI: 0.6%-16.9%) presented a recurrent mitral regurgitation (grade II). Conclusions In this initial experience, the Roman Arch technique, based on a single running suture, showed promising results as a technically simple and highly reproducible approach for mitral valve repair. Early echocardiographic outcomes were satisfactory. However, due to the limited sample size and short-term follow-up, larger and prospective studies are needed to confirm its long-term effectiveness and potential role within the spectrum of modern mitral valve repair strategies.