RE-LOCK and TRACK: a reproducible minimally invasive repair for bileaflet mitral disease

Abstract

Complex bileaflet and Barlow-type degenerative disease is among the most demanding substrates in reconstructive mitral surgery, where durable repair–preserving the subvalvular apparatus and left ventricular geometry–remains the goal [1]. Through a right mini-thoracotomy, limited exposure amplifies every source of intraoperative variability. Two pitfalls in bileaflet repair may compromise durability: leaving excessive height of the posterior leaflet, which displaces the coaptation line anteriorly and drives residual regurgitation and systolic anterior motion; and inappropriately sized anterior chordae, in which a small error in length may produce residual prolapse, restriction or recurrence. RE-LOCK and TRACK is a two-component, posterior-first protocol designed to control both, reproducibly, in the minimally invasive field (Fig. 1).