Midterm Outcome of the Edge-to-Edge Mitral Valve Repair in Mitral Regurgitation

Objective: The edge-to-edge mitral valve repair, invented by Alfieri and colleagues, introduced valve repair as a treatment option for patients with complex diseases where standard annuloplasty and related repair techniques are insufficient, due to annular calcification and patient frailty. We retrospectively evaluated the results of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) in patients who were undergoing aortic valve replacement.

Methods: From February 2012 to September 2017 42 patients were undergoing transaortic edge-to-edge mitral valve repair (40 without annuloplasty) with concomitant aortic valve replacement at a single institution. Preoperative and postoperative echocardiograms were compared. Home telephone follow up was conducted and postoperative morbidity was examined, including the need for reoperation, stroke and cardiac arrhythmia. 30 day survival and long-term survival were also determined. The mitral regurgitation (MR) was graded semiquantitatively as 0 (trace /none), mild (1+), moderate (2+) or moderate (3+) to severe (4+).

Results: The patients were 76.5 ± 8 years old. 62% of the patients were male. Median cardiopulmonary bypass time was 116 ± 38 minute and median cross-clamp time was 68 ± 25 minute. There was a significant improvement in preoperative versus postoperative median MR grade (2+ vs. 0; p < 0.05). Follow-up transthoracic echocardiograms in 24 patients obtained at a median of 10 months (range 3 - 19 months) and in 12 patients at a median of 34 months postoperatively (range: 21–53 months) showed mild (1+) grade of mitral regurgitation. Thirty-day survival was 94.1%. Long term survival at 12 and 24 months were 93% and 87% respectively. Mitral valve reoperation was conducted in one patient (2%), who was suffering of an endocarditis. A stroke occurred in 2 patients (5%). Cardiac arrhythmia was observed in 16 patients (38%). 8 patients (19%) suffered from atrial fibrillation and 9 patients (21%) of an atrioventricular block. 9 patients (21%) could be treated conservatively and 7 patients (17%) needed implantation of a pacemaker.

Conclusion: Transaortic edge-to-edge mitral valve repair can be safely performed during aortic valve replacement and improves even long-term MR grade. Postoperative cardiac arrhythmia occurs frequently. 56% of them could be treated successfully by conservative procedures.