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

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Interventional Cardiology

Background:

• Functional mitral regurgitation (FMR) complicates aortic valve replacement (AVR), particularly in frail patients.
• The management of FMR in elderly, frail patients undergoing AVR remains challenging.
• Left ventricular dilatation can exacerbate FMR, leading to hemodynamic instability.

Purpose of the Study:

• To evaluate the efficacy of a minimally invasive technique for managing FMR in a frail patient undergoing AVR.
• To assess the impact of addressing FMR on hemodynamic stability and cardiopulmonary bypass weaning.

Main Methods:

• A case report of an 82-year-old frail female with severe aortic regurgitation and moderate FMR (NYHA class III).
• Aortic valve replacement was performed without initial mitral valve intervention due to patient frailty.
• A central Alfieri edge-to-edge stitch was employed to correct FMR after AVR when hemodynamic instability occurred.

Main Results:

• The patient experienced hemodynamic instability and difficulty weaning from cardiopulmonary bypass due to severe FMR and left ventricular dilatation post-AVR.
• Placement of a central Alfieri edge-to-edge stitch successfully eliminated mitral regurgitation.
• Successful separation from cardiopulmonary bypass was achieved after the mitral valve intervention.

Conclusions:

• In frail patients undergoing AVR, FMR can lead to significant complications.
• The Alfieri edge-to-edge technique is a viable option for treating FMR in selected high-risk patients.
• This approach can improve hemodynamic stability and facilitate weaning from cardiopulmonary bypass.