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

Yoshihisa Morimoto,Takaki Sugimoto

doi:10.1186/s40792-017-0410-3

Abstract

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.

Highlights

Mitral regurgitation severity may decrease after isolated aortic valve replacement, it may not improve and may even worsen in a substantial proportion of patients, and a subsequent mitral valve procedure is associated with increased operative risk in such cases [1]
We report a case in which edge-to-edge repair was used to treat increased functional mitral regurgitation after aortic valve replacement
Uncommon in other circumstances, in this patient, the constellation of dilated ventricular cavity and left ventricular dysfunction caused by aortic valve replacement resulted in hemodynamically significant functional mitral regurgitation upon weaning from cardiopulmonary bypass

Summary

Introduction

Mitral regurgitation severity may decrease after isolated aortic valve replacement, it may not improve and may even worsen in a substantial proportion of patients, and a subsequent mitral valve procedure is associated with increased operative risk in such cases [1]. We report a case in which edge-to-edge repair was used to treat increased functional mitral regurgitation after aortic valve replacement. * Correspondence: yoshimor@gmail.com 1Department of Cardiovascular Surgery, Ako City Hospital, 1090 Nakahiro, Ako, Hyogo 678-0232, Japan Full list of author information is available at the end of the article moderate functional mitral valve regurgitation (Carpentier type IIIb mechanism, effective regurgitant orifice area [EROA] 0.1 cm2, regurgitant volume [RV] 13 mL, color area of MR 6.3 cm2, mitral annulus 27 mm, Fig. 1, Additional file 1: Video S1), and increased systolic pulmonary artery pressures 50 mmHg. In consideration of her frail condition and our expectation of difficult mitral valve exposure due to her very bent back, aortic valve replacement (Mitroflow 21 mm) without mitral surgery was performed.

Results

Conclusion