Abstract 17113: Transaortic Edge-to-edge Mitral Valve Repair for Functional Mitral Regurgitation in Patients Undergoing Aortic Valve Replacement: A 13-year Experience
Objective: The study aim was to evaluate the safety and efficacy of a transaortic edge-to-edge mitral valve repair (Alfieri stitch) for moderate or greater (≥2+) functional mitral regurgitation (MR) in patients undergoing aortic valve replacement, who were deemed to be high risk for conventional double valve surgery.
Methods: We retrospectively evaluated all patients who underwent aortic valve replacement combined with a transaortic edge-to-edge mitral valve repair for ≥2+ functional MR, between February 2002 and April 2015. The MR was graded as 0 (trace/none), mild (1+), moderate (2+), moderate-to-severe (3+), or severe (4+).
Results: There were 40 consecutive patients identified; 32 had aortic stenosis and 8 aortic regurgitation. The mean age was 77.5 ± 5 years, and 34 (85%) were male. Coronary artery disease was present in 26 (65%) patients, while 14 (35%) had no or non-obstructive disease. Sixteen (40%) patients had a prior history of cardiac surgery, and the mean EuroSCORE II was 14.3% ± 12.9. Nine patients (22.5%) underwent concomitant coronary artery bypass grafting. At a median of 1 month (IQR 0.75-10) follow-up, there were significant improvements in preoperative versus postoperative median MR grade (3 versus 1, p<0.001), and mean left ventricular ejection fraction (34% versus 41%, p=0.018), left ventricular end-diastolic dimension (54mm versus 49mm, p=0.005), and pulmonary artery systolic pressure (49mmHg versus 35mmHg, p<0.001). Persistent 3-4+ MR occurred in 2 (5%) patients. In 12 patients with at least 6 month echocardiographic follow-up (mean = 18 ± 11 months), a sustained improvement in median MR grade (4 versus 1, p<0.001), and mean left ventricular ejection fraction (40% versus 53%, p=0.003), left ventricular end-diastolic dimension (53mm versus 41mm, p=0.005), and pulmonary artery systolic pressure (46mmHg versus 33mmHg, p<0.039) was observed, with persistent 3-4+ MR occurring in 1 (8.3%) patient. Actuarial survival at 1, 3, and 4.5-years was 82% ± 6, 71% ± 8, and 65% ± 10, respectively.
Conclusions: A transaortic edge-to-edge repair for ≥2+ functional MR can be safely performed during aortic valve replacement, and confers early and mid-term improvements in MR grade, left ventricular remodeling, and pulmonary hemodynamics.
Author Disclosures: C.G. Mihos: None. M. Laurrari-Reyes: None. J. Hung: None. O. Santana: None.
- © 2015 by American Heart Association, Inc.