Alfieri stitch in mini-thoracotomy repair of degenerative mitral regurgitation: Useful tool or bad idea?

Authors: Brittany A. Zwischenberger, MD_­¹, Jeffrey G. Gaca, MD¹, Keith Carr, BS¹, Andrew Wang, MD², Donald D. Glower¹, MD

 

Objective: The Alfieri stitch is a mitral repair technique that can easily be applied in less invasive approaches to the mitral valve.  However, the Alfieri stitch is seldom used and has raised concern of producing mitral stenosis or recurrent regurgitation. 

Methods: 1183 consecutive patients undergoing repair of degenerative mitral regurgitation via right mini-thoracotomy from 1997 to 2019 were examined from a prospectively maintained database.  Propensity score matching was performed on patients with and without Alfieri stitch to compare outcomes up to 10-years. 

Conclusions: In selected patients undergoing repair of degenerative mitral regurgitation via right mini-thoracotomy approach, use of the Alfieri stitch can be associated with only slightly higher mean mitral gradient, without significantly increased risk of mitral reoperation or recurrent regurgitation at 10 years.  Based on early 10-year data, the Alfieri stitch may be a safe and easily applied adjunct to minimally invasive mitral repair in selected patients.