Edge-to-edge technique for mitral valve repair: medium-term results with echocardiographic follow-up.
BACKGROUND
The follow-up data for the Alfieri edge-to-edge technique of mitral valve repair is still a matter of interest. We describe the medium-term results of a single surgeon's practice with clinical and echocardiographic follow-up.


METHODS
Between October 1998 and July 2003, 41 patients underwent the Alfieri repair. Mean age of the patients was 68 years, 34.2% were female, 26 (63.41%) had New York Heart Association (NHYA) class III symptoms, and 19 (46.3%) had concomitant coronary disease. Preoperatively, 26 patients had grade 4+, 12 patients had grade 3+, and 3 patients had grade 2+ mitral regurgitation. The pathologies included myxomatous degeneration (73.2%), ischemic cardiomyopathy (12.2%), rheumatic (4.9%), dilated cardiomyopathy (2.4%), previous infection (2.4%), and indeterminate pathology (4.9%). Thirty-three patients (80.4%) had a ring annuloplasty, and 17 (41.4%) had concomitant coronary surgery. Median duration of echocardiographic follow-up was 22.1 months (range, 0.2 to 60.1).


RESULTS
Hospital mortality was 4.8% (2 of 41). Four patients underwent reintervention on the mitral valve. At follow-up, 26 patients (66.6%) were in NYHA class I. The actuarial freedom from death or reoperation at 5 years was 80.4%. Transthoracic echocardiography was performed in 94.3% of the 35 hospital survivors who did not undergo reoperation. Twenty-nine patients (87.8%) had grade 0-1+ mitral regurgitation, and the remainder had grade 2+ mitral regurgitation. All patients discharged from hospital were alive in December 2005.


CONCLUSIONS
The Alfieri edge-to-edge repair for mitral regurgitation is a safe and useful technique and should be included in the armamentarium of the mitral valve surgeon.
Kuduvalli
Manoj
M
Department of Cardiothoracic Surgery, Cardiothoracic Centre Liverpool, Liverpool, United Kingdom. manojkud@hotmail.com
Ghotkar
Sanjay V
SV
Grayson
Antony D
AD
Fabri
Brian M
BM
D000328:Adult; D000368:Aged; D006348:Cardiac Surgical Procedures / Q000379:methods*; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000601:surgery*; D012086:Reoperation; D013997:Time Factors; D016896:Treatment Outcome