Alfieri versus conventional repair for bileaflet mitral valve prolapseCentral MessagePerspective
Catherine M. Wagner, MD, MSc,
Whitney Fu, MD,
Robert B. Hawkins, MD, MSc,
Matthew A. Romano, MD,
Gorav Ailawadi, MD, MBA,
Steven F. Bolling, MD
Affiliations
Catherine M. Wagner, MD, MSc
Address for reprints: Catherine M. Wagner, MD, MSc, 1500 E Medical Center Dr, Ann Arbor, MI 48109.; Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; National Clinician Scholar's Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Mich; Department of Surgery, University of Michigan, Ann Arbor, Mich
Whitney Fu, MD
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; National Clinician Scholar's Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Mich; Department of Surgery, University of Michigan, Ann Arbor, Mich
Robert B. Hawkins, MD, MSc
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; National Clinician Scholar's Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Mich; Department of Surgery, University of Michigan, Ann Arbor, Mich
Matthew A. Romano, MD
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; National Clinician Scholar's Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Mich; Department of Surgery, University of Michigan, Ann Arbor, Mich
Gorav Ailawadi, MD, MBA
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; National Clinician Scholar's Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Mich; Department of Surgery, University of Michigan, Ann Arbor, Mich
Steven F. Bolling, MD
Department of Cardiac Surgery, University of Michigan, Ann Arbor, Mich; National Clinician Scholar's Program, Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Mich; Department of Surgery, University of Michigan, Ann Arbor, Mich
Objective: Mitral valve repair for bileaflet prolapse can be complex, involving multiple chords or resection. The Alfieri technique for bileaflet disease is simple but may be associated with mitral stenosis or recurrent mitral regurgitation. Outcomes of patients with bileaflet prolapse undergoing mitral valve repair using the Alfieri versus conventional chord/resection techniques were compared. Methods: Adults undergoing mitral valve repair for bileaflet prolapse for degenerative disease from 2017 to 2023 were stratified by repair technique. Outcomes including operative mortality and echocardiogram data were compared. Time to event analysis was used to characterize freedom from recurrent mitral regurgitation (moderate or greater mitral regurgitation). Results: Among 188 patients with bileaflet prolapse, 37% (70) were repaired with the Alfieri and the remaining patients were repaired with chords/resection. Compared with chords/resection, patients undergoing the Alfieri had shorter cardiopulmonary bypass and crossclamp times. Operative mortality (0% [0/70] vs 2% [2/118], P = .27) was similar between both techniques. The mean mitral gradient was low and similar for the Alfieri versus chords/resection (3 vs 3, P = .34). Development of recurrent mitral regurgitation at 2 years, incorporating the competing risk of death and mitral reintervention, was 4.3% (95% CI, 1.5%-9.3%) for the Alfieri technique and 5.8% (95% CI, 2.2%-11.8%) for chord/resection (P = .83). Conclusions: Both the Alfieri and chord/resection techniques had low rates of recurrent mitral regurgitation at 2 years. The mitral valve gradient was low and similar regardless of technique; thus, those who received the Alfieri technique did not have an increased rate of mitral stenosis. The Alfieri may be an underused technique for bileaflet prolapse.
