title: Transaortic repair of the mitral valve in patients undergoing aortic valve replacement.
abstract: OBJECTIVE
  We retrospectively evaluated the results of edge-to-edge (Alfieri) repair of the mitral valve via a transaortic approach in patients undergoing aortic valve replacement (AVR) and who had significant mitral regurgitation (MR).
  
  
  METHODS
  From July 2000 to June 2006, 13 patients underwent edge-to-edge repair of the mitral valve via a transaortic approach with concomitant AVR. Patients were considered eligible for the transaortic Alfieri repair if the preoperative transesophageal echocardiogram indicated that the MR jet originated in the middle portion (A2/P2 segments) of the mitral valve. A postoperative transesophageal echocardiogram and follow-up transthoracic echocardiograms were obtained.
  
  
  RESULTS
  There was no operative mortality. There was a significant improvement in the median MR grade from 3 (interquartile range [IQR], 2-4) preoperatively to 1 (IQR, 1-1) postoperatively (P < .0001). The ejection fraction (EF) remained stable, with mean preoperative and postoperative EFs of 44.2% + or - 14.9% and 46.27% + or - 11.6%, respectively (P = .4). No mitral stenosis was noted in any of the patients following edge-to-edge repair. Follow-up transthoracic echocardiograms obtained at a mean of 12.5 months postoperatively (range, 1-34 months) showed a median MR grade of 1 (IQR, 1-2) with no worsening compared with immediately postoperatively (P = .4).
  
  
  CONCLUSIONS
  Transaortic edge-to-edge repair of the mitral valve in patients undergoing AVR is feasible. The postoperative improvement in MR was maintained at the midterm follow-up.
authors.affiliation: Echocardiography Laboratory, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, Florida 33140, USA. osantana@msmc.com
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.forename: Kshamaya B
authors.initials: KB
authors.lastname: Panchamukhi
authors.forename: Roberto
authors.initials: R
authors.lastname: Grana
authors.forename: Ernest A
authors.initials: EA
authors.lastname: Traad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications* / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000150:complications* / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome