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Transaortic edge-to-edge Alfieri mitral repair is an excellent yet simple tool for certain clinical circumstances. These include complex surgeries on patients with weak ventricles, where an expedited clamp time is crucial. This is particularly relevant when the aorta is being opened for the index operation and when the mechanism of mitral insufficiency is expected to improve with the index operation. However, mitral insufficiency secondary to leaflet restrictions or perforations may not be suitable for this technique.
The author presents the case of an embolized TAVR in a patient with two previous sternotomies, totally occluded native coronaries, patent grafts under the sternum, severe bioprosthetic aortic insufficiency, and decompensated heart failure with biventricular systolic dysfunction. In this context, the author presents the utility and technique of transaortic Alfieri mitral repair.
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2 Comments
Good solution for a difficult problem. We have used this technique for LAVDS too with a transapical approach using endoscopic instruments with success.
Its an effective and simple technique for this subset of patients. We have been using this technique for almost one and half decade. We published our early experience of 16 cases in the year 2017.https://www.sciencedirect.com/science/article/pii/S0022522317311856