ABSTRACT 94

MID-TERM RESULTS OF THE ALFIERI BI-LEAFLET REPAIR

Jai Raman, Siven Seevanayagam, John Cheung, Brian Buxton.
Department of Cardiac Surgery, Austin & Repatriation Medical Centre, Heidelberg, Melbourne, Victoria, Australia.

Introduction:  Mitral valve regurgitation (MR) due to bileaflet prolapse of the mitral valve (MV), and iscemic causes can be difficult to repair.  We report on our mid-term experience with the Alfieri edge-to-edge repair, which has been advocated as an option in these patients.

Methods:  Twenty four patients with MR underwent the Alfieri repair between January, 1998 and September, 2000 (Group 1).  Etiology included 14 cases of degenerative MV disease, 6 of ischemic MR, 3 of mitral annular dilatation and one in the setting of MV endocarditis.  There were 3 conversions to valve replacement intra-operatively.  During the same period, MV replacement was performed in 12 patients for similar indications (Group 2).

Results:  There were no early deaths in Group 1 with one late non-cardiac death.  All patients in group 1 were alive at a mean echocardiographic follow-up of 15 months (range: 1-28 months), with significant improvement in mitral regurgitation, LV function and NYHA functional class.  The majority of patients in group 1 had trivial to mild MR on the post-operative echo with a mean MV gradient of 3.8 mm Hg, with no thrombo-embolic events.  There was one sudden death in group 2, 2 thrombo-embolic events, 2 major bleeding episodes and a mean MV gradient of 5.2 mm Hg (p=ns).

Conclusions:  The Alfieri Edge-to-edge Mitral Valve Repair is a versatile alternative to MV replacement in MR due to bileaflet involvement and ischemic causes, with a lower risk of morbidity.  Long-term follow-up is required to evaluate the durability of this technique.