Functional (secondary) mitral regurgitation (MR) commonly accompanies aortic valve pathology as a consequence of left ventricular dilatation, which increases interpapillary muscle distance and impairs mitral leaflet coaptation. While correction of the primary aortic valve lesion often results in improvement of mild-to-moderate MR through reverse ventricular remodeling, significant MR frequently persists despite successful aortic valve surgery. Residual MR is associated with adverse clinical outcomes and may negatively affect postoperative recovery. However, concomitant mitral valve intervention during complex aortic root procedures increases operative complexity, cross-clamp time, and myocardial ischemia. The transaortic edge-to-edge (Alfieri) mitral repair offers a simple adjunctive technique that enables correction of MR through the aortic root, potentially reducing operative burden while improving postoperative outcomes.
The authors demonstrate a simple transaortic Alfieri stitch performed during a concomitant Bentall procedure and hemiarch repair. After the induction of general anesthesia and the establishment of cardiopulmonary bypass via aortocaval cannulation, the aortic valve was excised and the mitral valve was assessed through the aortic root. The midportions of the A2 and P2 segments in an area free of chordal attachments were approximated with a 4-0 polypropylene horizontal mattress suture placed 3–4 mm from the leaflet edges, which created a central edge-to-edge repair.
References
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