Edge-to-edge Alfieri technique for mitral valve repair

Bonis, Michele De; Lapenna, Elisabetta; Alfieri, Ottavio

doi:10.1097/hco.0b013e32835b9256

Cited by 18 publications

(8 citation statements)

References 37 publications

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“…Careful patient selection is imperative to achieving a durable edge-to-edge mitral valve repair, and these parameters include: (1) an MR jet originating from the A2 to P2 portion of the mitral valve, (2) normal annular anatomy with limited to no dilatation, (3) no history of rheumatic heart disease, and (4) limited annular and/or leaflet calcification. 9,12,[24][25][26] In patients with a dilated or calcified annulus or in the setting of rheumatic leaflet degeneration, the inherent pathology limits normal annular mechanics, imparts an increased stress on the edge-toedge suture and mitral leaflets, and predisposes to suboptimal outcomes. 27 Insufficient amelioration of functional MR may also occur in the setting of asymmetric leaflet tethering, in which the MR is often eccentric and may not amenable to an edge-toedge repair.…”

Section: Discussionmentioning

confidence: 99%

Transaortic Edge-To-Edge Repair for Functional Mitral Regurgitation during Aortic Valve Replacement: A 13-Year Experience

Mihos

Larrauri-Reyes

Hung

et al. 2016

Innovations�(Phila)

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Objective The study evaluated the feasibility of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) for moderate or greater (≥2+) functional mitral regurgitation (MR) in high-risk patients undergoing aortic valve replacement. Methods We retrospectively evaluated 40 consecutive patients who underwent aortic valve replacement combined with a transaortic edge-to-edge mitral valve repair for 2+ or greater functional MR, between February 2002 and April 2015. The MR was graded semiquantitatively as 0 (trace/none), mild moderate (2+), or moderate to severe (3–4+). Results Thirty-two patients had aortic stenosis, and eight had aortic regurgitation. The mean ± standard deviation (SD) age was 77.5 ± 5 years, 34 (85%) were male, and the mean ± SD EuroSCORE II was 14.3% ± 12.9. At a median follow-up of 1 month (interquartile range, 0.75–10), there were significant improvements in preoperative versus postoperative median MR grade (3+ vs 1+, P < 0.001), mean left ventricular ejection fraction (34% vs 41%, P = 0.018), left ventricular end-diastolic diameter (54 vs 49 mm, P = 0.005), and pulmonary artery systolic pressure (49 vs 35 mm Hg, P < 0.001). Persistent 3 to 4+ MR occurred in two patients (5%). In 12 patients with at least 6-month follow-up (mean ± SD, 18 ± 11 months), a sustained improvement in all echocardiographic parameters was observed, with persistent 3 to 4+ MR occurring in one patient (8.3%). Actuarial survival at 1, 3, and 4.5 years was 82% ± 6, 71% ± 8, and 65% ± 10, respectively. Conclusions A transaortic edge-to-edge repair for 2+ or greater functional MR can be safely performed during aortic valve replacement and is associated with improvements in MR grade, left ventricular remodeling, and pulmonary hemodynamics.

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Section: Discussionmentioning

confidence: 99%

Transaortic Edge-To-Edge Repair for Functional Mitral Regurgitation during Aortic Valve Replacement: A 13-Year Experience

Mihos

Larrauri-Reyes

Hung

et al. 2016

Innovations�(Phila)

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“…Possible catheter-based approaches for the treatment of MR include transapical or transseptal valve repair or replacement, placement of annular tightening devices, and insertion of artificial chordae. The "edge-to-edge" surgical repair technique, making a "double-orifice" MV, was the first to be adapted for the percutaneous approach with the MitraClip System (Abbott Vascular, Santa Clara, CA, USA), reaching over time more than 70,000 implants worldwide, since its first use in humans in 2003 [11] . Later in 2019, the new PASCAL repair system (Edwards Lifesciences, Irvine, CA, USA) received CE mark for the percutaneous "edge-to-edge" repair treatment of MR, further expanding the therapeutic options available to the interventional cardiologist and the population eligible for treatment.…”

Section: Etiology and Treatment Of Primary Mrmentioning

confidence: 99%

Percutaneous “edge-to-edge” leaflet repair in patient with primary mitral valve regurgitation

Masiero¹,

Rodinò²,

Tarantini³

2020

MIS

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Mitral regurgitation (MR) is the most common left-sided heart valve disease in developed countries with a constantly rising number of patients requiring hospitalization or intervention. Organic MR is defined as a primary structural abnormality of the mitral valve (MV) apparatus which may be caused by a broad set of pathological processes, among which myxomatous degeneration of the leaflets causing MV prolapse is the most common. If left untreated, chronic severe MR leads to serious adverse outcomes, from heart failure to death, but medical therapy is unable to change the natural history of the disease. Surgical correction, by means of valve repair or replacement, is the gold standard for the treatment of symptomatic patients with severe primary MR. However, surgery is not feasible for a large percentage of patients because of old age, reduced left ventricular ejection fraction and the presence of severe comorbidities. Therefore, in recent years, several percutaneous therapeutic alternatives suitable for high or prohibitive surgical risk patients were developed. In this review we discuss the transcatheter treatment of primary MR, from available evidence to technical practice, with a focus on the percutaneous "edge-to-edge" leaflet repair performed with the MitraClip System and the PASCAL Repair System.

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“…86 This technique is simple and easily reproducible and has demonstrated acceptable outcome in patients with degenerative MV disease. [87][88][89] Seventeen-year freedoms from reoperation for mitral regurgitation and severe mitral regurgitation are 90% and 80%, respectively. 90 Due to the risk of inducing stenosis, the edge-to-edge repair is not recommended in patients with a small MV area.…”

Section: Edge-to-edge Repair (Alfieri Stitch)mentioning

confidence: 99%

Choosing the “Best” surgical techniques for mitral valve repair: Lessons from the literature

et al. 2019

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Mitral valve (MV) repair is the procedure of choice to correct mitral regurgitation caused by degenerative MV disease, due to its well‐documented superiority over MV replacement. Repair of the MV is feasible in more than 95% of such patients and restores valve function and preserve ventricular function. Surgeons choose from a wide variety of mitral repair techniques, with the ultimate procedure based upon the pathology and the particular surgeon's personal preference. As a result, there is considerable controversy concerning choice of repair techniques and prostheses (ie, annuloplasty device). This targeted review of available data concerning repair of the degenerative valve will inform surgeon decision‐making in MV repair.

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Edge-to-edge Alfieri technique for mitral valve repair

Cited by 18 publications

References 37 publications

Transaortic Edge-To-Edge Repair for Functional Mitral Regurgitation during Aortic Valve Replacement: A 13-Year Experience

Transaortic Edge-To-Edge Repair for Functional Mitral Regurgitation during Aortic Valve Replacement: A 13-Year Experience

Percutaneous “edge-to-edge” leaflet repair in patient with primary mitral valve regurgitation

Choosing the “Best” surgical techniques for mitral valve repair: Lessons from the literature

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