Invited commentary to: Intraoperative echocardiographic assessment of mitral valve translocation

In this issue, Strauss et al. [1] present a novel technique of using autologous pericardium for mitral valve (MV) translocation to improve coaptation in patients with secondary mitral regurgitation (MR). They have demonstrated significantly improved zones of coaptation and reductions in the tenting volume of translocated MVs. While longitudinal durability has not been established, the short-term results are promising and provide an alternative surgical therapy for a challenging clinical problem [2]. The current paradigm of surgical management is based on a restrictive annuloplasty to optimize leaflet coaptation in patients with secondary MR. Besides being a global solution for an often regional remodelling problem, this therapy has demonstrated poor durability with a significant rate of recurrence of MR [3]. In vitro selective flexibility of certain annuloplasty devices has not been demonstrated in vivo, with most rings ‘fixing’ the mitral annulus, resulting in a significant loss of dynamism [4]. While the authors did not perform pre- and post-procedural dynamic analyses of the MV apparatus, it is presumed that it was minimally affected. Using specialized software, it is now possible to demonstrate the preservation or improvement of annular dynamics [5]. In this reference, it would be interesting to know the impact of translocation on the non-planarity of the mitral annulus to assess the degree of reverse remodelling.