RE-LOCK and TRACK: A Reproducible Minimally Invasive Repair for Bileaflet Mitral Disease

Complex bileaflet and Barlow-type degenerative disease remains among the most demanding substrates in reconstructive mitral surgery, and a right mini-thoracotomy amplifies every source of intraoperative variability. Two determinants dominate durability: excessive posterior leaflet height, which displaces the coaptation line anteriorly and drives residual regurgitation and systolic anterior motion; and, in anterior prolapse, neochordal length, where a millimetric error produces residual prolapse, restriction or recurrence. We describe RE-LOCK and TRACK, a two-component, posterior-first protocol designed to control both reproducibly. RE-LOCK relocates the redundant posterior leaflet head towards the annular plane and anchors it to a stable posterior reference, converting a mobile prolapsing edge into a controlled hinge and establishing a low, posteriorised coaptation shelf; posterior neochordae are not used. TRACK then calibrates anterior support: expanded-polytetrafluoroethylene neochordae anchored to the papillary head are advanced against a temporary annular guide kept coplanar with the annulus, so that length is set against an anatomical reference rather than by visual estimation or ventricular loading. Complete ring annuloplasty stabilises the result, and intraoperative transoesophageal echocardiography governs any revision. By fixing the sequence, platform first and calibration second, the protocol converts individually demanding manoeuvres into a repeatable, teachable operation particularly well suited to the minimally invasive field.