Introduction
Mitral valve repair (MVr) is recognized as being the best treatment for severe mitral regurgitation, especially when degenerative[1] . Since the beginning of MVr, many options have been advocated. From the wide quadrangular resection by Carpentier to the triangular resection by the Mayo Clinic. Overall, the general trend is to resect, but less than previously - to avoid tension and not to plicate the annulus. Then came the option of not resecting at all, as opposed to resecting. It is sometimes obvious that in dystrophic mitral regurgitation with a thin ruptured chord no resection can be a good option as there is no excess tissue. On the contrary, a typical Barlow shows excess tissue, and even coexisting areas with prolapsed tissue and billowing tissue with no prolapse. MVr should not follow any dogma, but just make sense. The aim of any repair is to achieve a good surface of coaptation, with the smoothest surface possible. Coaptation height should be assessed in every repair at the end after weaning from by-pass as it is a key issue for long term durability.
« Resect or respect » concepts are not in opposition: they just do not apply to the same patients. Those who favor the “respect rather than resect” do resect whenever needed, and those who resect do “resect with respect” and do not plicate the annulus , which in the real world does not oppose as much as one would believe, one technique to the other. It seems also fair to mention that there are few long-term results with longitudinal follow up beyond 10 years, and that those published refer if not all to the resection philosophy.