Outcomes of transaortic edge-to-edge repair of the mitral valve in patients undergoing minimally invasive aortic valve replacement

Aortic valve replacement in patients with a left ventricular ejection fraction ≤35% performed via a minimally invasive right thoracotomy

“…Despite the severely reduced left ventricular systolic function and clinical risk profile, a right thoracotomy approach resulted in acceptable perioperative outcomes and a low 30-day mortality, with an excellent MV repair rate of 91.7%. Approximately twothirds of the patients underwent a transaortic edge-to-edge MV repair, which avoids extensive mediastinal dissection and the need for an atriotomy, and requires approximately 10 additional minutes in operative time (19,20,31,32). Thus, the decreased surgical trauma afforded by this technique may be of particular benefit in high-risk patients (33).…”

“…The edge-to-edge repair was performed 1 cm proximal to the leaflet free edges, utilizing a 4-0 Prolene (Ethicon, Somerville, NJ USA) mattress suture reinforced with Teflon (Ethicon) pledgets on the ventricular side of the MV. Patients were candidates for a transaortic edge-to-edge MV repair if the mitral regurgitation jet originated from the A2-P2 leaflet scallops, there was limited leaflet and annular calcification, and there was no significant annular dilatation (19,20).…”

“…No patient required conversion to sternotomy for inadequate surgical field exposure. The median total mechanical ventilation time and intensive care unit length of stay were 14 (IQR,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20) and 42 hours (IQR, in the isolated AVR group, and 16.5 hours (IQR, 12-61.5 hours) and 95.5 hours (IQR, in the AVR plus MV surgery group, respectively. The most common post-operative complication was newonset atrial fibrillation, which occurred in 15 (29.4%) isolated AVR and 4 (16.7%) AVR plus MV surgery patients.…”

Trans-aortic Alfieri stitch at the time of septal myectomy for hypertrophic obstructive cardiomyopathy

“…The trans‐aortic approach of mitral valve repair using an Alfieri stitch has been previously described . Mihos et al reported a series of 55 high‐risk patients without HOCM who underwent transaortic edge‐to‐edge mitral repair for MR . These patients were undergoing aortic valve replacement, but were deemed too high risk for traditional double valve surgery.…”

“…This was similar to that reported by other groups using trans-aortic edge-to-edge mitral repair. 16 The transaortic mitral repair technique may be limited in some patients where transaortic exposure of the posterior mitral leaflet is difficult or where the mitral valve has disease that would not be addressed by an edge-to-edge repair.…”