Alfieri stitch for temporary severe functional mitral regurgitation after aortic valve replacement

The outcome in functional mitral regurgitation after aortic valve replacement is unclear. A frail 82-year-old woman with severe aortic valve regurgitation and mild to moderate functional mitral valve regurgitation (NYHA functional class III) was referred to our clinic. In consideration of her frail condition, aortic valve replacement without mitral surgery was performed. She had hemodynamic instability and difficulty to wean off cardiopulmonary bypass caused by severe functional mitral valve regurgitation with left ventricular dilatation. A central Alfieri edge-to-edge stitch was placed between the anatomical middle of the two leaflets of the mitral valve after reinstitution of cardiopulmonary bypass. This eliminated the mitral regurgitation, which enabled successful separation from cardiopulmonary bypass.