What does this research mean for the field?

Minimally invasive mitral valve repair achieves comparable 5-year freedom from reoperation and clinical outcomes whether performed using leaflet preservation ('Respect'), resection ('Resect'), or a combined approach. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To compare the longer-term valve durability and clinical outcomes of leaflet preservation ('Respect'), leaflet resection ('Resect'), and combined approaches in minimally invasive mitral valve repair for degenerative mitral regurgitation.

July 1, 2026Journal of Cardiothoracic SurgeryOpen Access

Minimally invasive mitral valve repair revisited: Respect or Resect? Amidst competing risks

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Degenerative mitral regurgitation (n=447). Intervention: Leaflet preservation ('Respect') vs. Leaflet resection ('Resect') or combined approach ('Both'). Primary outcome: Freedom from mitral valve-related reoperation and mitral regurgitation severity (p=0.647).

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Key result

Respect, Resect, and combined minimally invasive mitral valve repair techniques yield similar 5-year reoperation rates.

P=0.647
n=447

Why the study?

The optimal surgical strategy for degenerative mitral regurgitation—leaflet preservation (Respect) versus leaflet resection (Resect) or a combination (Both)—remains debated in minimally invasive mitral valve surgery.

Does the surgical technique ('Respect', 'Resect', or 'Both') affect freedom from reoperation and MR severity in patients undergoing minimally invasive mitral valve repair for degenerative mitral regurgitation?

Population

447 consecutive patients undergoing isolated MVr via right lateral mini-thoracotomy

Comparison

Respect vs Resect vs Both repair techniques

Design

Single-center retrospective cohort study

Follow-up

Mean follow-up of 5 years

Authors

RBR. W. BrooksUniversity of Zurich PBP. BiaggiKlinik Hirslanden OGO. GaemperliKlinik Hirslanden

Discussion

Member takes

Implication

All three MVr techniques show equivalent durability in MIMVS; supports morphology-guided individualized repair but leaves open need for RCTs.

Key Points

To compare the longer-term valve durability and clinical outcomes of leaflet preservation ('Respect'), leaflet resection ('Resect'), and combined approaches in minimally invasive mitral valve repair for degenerative mitral regurgitation.
Analyzed 447 consecutive patients who underwent isolated minimally invasive mitral valve repair via right lateral mini-thoracotomy between 2006 and 2014, stratified into 'Respect' (n = 293), 'Resect' (n = 109), and 'Both' (n = 45).
Evaluated primary endpoints of freedom from mitral valve–related reoperation and mitral regurgitation severity, with secondary endpoints of all-cause mortality and MACCE, utilizing Fine–Gray competing risk regression to account for death.
At a mean follow-up of 5 years, durable mitral valve competence was present in 88.4% of patients (MR grade ≤ I).
Five-year freedom from mitral valve–related reoperation was 93.3% with no significant difference between techniques (P = 0.647), a finding confirmed by competing risk analysis.
Five-year survival was 94.0% and 5-year freedom from MACCE was 96.8% across the cohort, alongside low in-hospital mortality of 0.7% and cerebrovascular event rates of 0.9%.

Study Design

Type

Cohort (n=447)

Multicenter

Structured PICO

Population

447 patients with degenerative mitral regurgitation undergoing isolated minimally invasive mitral valve repair, followed for a mean of 5 years.

Exposure

Mitral valve repair using the 'Respect' technique (leaflet preservation with or without neochordal implantation, n=293) or a combined approach ('Both', n=45)

Comparator

Mitral valve repair using the 'Resect' technique (leaflet resection, n=109)

Outcome

Freedom from mitral valve-related reoperation and mitral regurgitation severity during follow-uphard clinical

Main Result

p-value: p=0.647

Different minimally invasive mitral valve repair techniques ('Respect', 'Resect', or 'Both') yield equally favorable long-term outcomes for degenerative mitral regurgitation, supporting a morphology-guided individualized approach.

Cite This Study

Brooks et al. (2026) conducted a cohort in Degenerative mitral regurgitation (n=447). Leaflet preservation ('Respect') vs. Leaflet resection ('Resect') or combined approach ('Both') was evaluated on Freedom from mitral valve-related reoperation and mitral regurgitation severity (p=0.647). Minimally invasive mitral valve repair using 'Respect', 'Resect', or combined techniques yielded similar 5-year freedom from mitral valve-related reoperation (93.3% overall; P=0.647).

synapsesocial.com/papers/6a44af895cd2549c8bc447b2 https://doi.org/10.1186/s13019-026-04350-z

Topics

Transcatheter Edge-to-Edge Repair (TEER)

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Implication

All three MVr techniques show equivalent durability in MIMVS; supports morphology-guided individualized repair but leaves open need for RCTs.

Minimally invasive mitral valve repair revisited: Respect or Resect? Amidst competing risks

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Minimally invasive mitral valve repair revisited: Respect or Resect? Amidst competing risks

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider