Transaortic Repair of the Mitral Valve in Patients Undergoing Aortic Valve Replacement
Objective: We retrospectively evaluated the results of edge-to-edge (Alfieri) repair of the mitral valve via a transaortic approach in patients undergoing aortic valve replacement (AVR) and who had significant mitral regurgitation (MR).
Methods: From July 2000 to June 2006, 13 patients underwent edge-to-edge repair of the mitral valve via a transaortic approach with concomitant AVR. Patients were considered eligible for the transaortic Alfieri repair if the preoperative transesophageal echocardiogram indicated that the MR jet originated in the middle portion (A2/P2 segments) of the mitral valve. A postoperative transesophageal echocardiogram and follow-up transthoracic echocardiograms were obtained.
Results: There was no operative mortality. There was a significant improvement in the median MR grade from 3 (interquartile range [IQR], 2-4) preoperatively to 1 (IQR, 1-1) postoperatively (P < .0001). The ejection fraction (EF) remained stable, with mean preoperative and postoperative EFs of 44.2% ± 14.9% and 46.27% ± 11.6%, respectively (P = .4). No mitral stenosis was noted in any of the patients following edge-to-edge repair. Follow-up transthoracic echocardiograms obtained at a mean of 12.5 months postoperatively (range, 1-34 months) showed a median MR grade of 1 (IQR, 1-2) with no worsening compared with immediately postoperatively (P = .4).
Conclusion: Transaortic edge-to-edge repair of the mitral valve in patients undergoing AVR is feasible. The postoperative improvement in MR was maintained at the midterm follow-up.
Barreiro CJ, Patel ND, Fitton TP, et al. 2005. Aortic valve replacement and concomitant mitral valve regurgitation in the elderly. Impact on survival and functional outcome. Circulation 112(suppl I):I443-7.nBrasch AV, Khan SS, DeRobertis MA, Kong JHK, Chiu J, Siegel RJ. 2000. Change in mitral regurgitation severity after aortic valve replacement for aortic stenosis. Am J Cardiol 85:1271-4.nCrawford ES, Coselli JS. 1998. Marfan's syndrome: combined composite valve graft replacement of the aortic root and transaortic mitral valve replacement. Ann Thorac Surg 45:296-302.nGalloway AC, Grossi EA, Baumann FG, et al. 1992. Multiple valve operation for advanced valvular heart disease: results and risk factors in 513 patients. J Am Coll Cardiol 19:725-32.nKällner G, van der Linden J, Hadjinikolaou L, Lindblom D. 2001. Transaortic approach for the Alfieri stitch. Ann Thorac Surg 71:378-80.nKavarana MN, Barbone A, Edwards NM, Levinsson MM, Oz MC. 2000. Transaortic repair of mitral regurgitation. Heart Surg Forum 3:24-8.nLozonschi L, Sirak JH, Michler RE. 2007. Transaortic delivery of the transmitral lesion in a complete maze procedure. Ann Thorac Surg 83:1904-5.nMaisano F, Caldarola A, Blasio A, De Bonis M, La Canna G, Alfieri O. 2003. Midterm results of edge-to-edge mitral valve repair without annuloplasty. J Thorac Cardiovasc Surg 126:1987-97.nMaisano F, Torracca L, Oppizzi M, et al. 1998. The edge-to-edge technique: a simplified method to correct mitral insufficiency. Eur J Cardiothorac Surg 13:240-6.nMatsumoto H, Sakata R, Kinjo T, Iguro Y. 2005. Posterior mitral annuloplasty through the aortic root. Ann Thorac Cardiovasc Surg 11:264-6.nMoazami N, Diodato MD, Moon MR, et al. 2004. Does functional mitral regurgitation improve with isolated aortic valve replacement? J Card Surg 19:444-8.nMueller XM, Tevaearai HT, Stumpe F, et al. 1998. Long-term results of mitral-aortic valve operations. J Thorac Cardiovasc Surg 115:1298-309.nNajafi H, Hemp JR. 1994. Mitral valve replacement through the aortic root. J Thorac Cardiovasc Surg 107:1334-6.nShanker VR, Yadav S, Hodge AJ. 2005. Coronary artery bypass grafting with valvular heart surgery after pneumonectomy. ANZ J Surg 75:88-90.n
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