Mitral valve repair, rather than replacement, has become the preferred surgical treatment for severe mitral regurgitation (MR).
1 The mainstay of surgical repair is annuloplasty, which is associated with excellent outcome.
2 In 1991, a simple technique for mitral valve repair was introduced by Otavio Alfieri, involving the placement of a surgical suture in the mid portion of the anterior and posterior leaflets, creating a double-orifice mitral valve.
3 This technique ensures a fixed area of coaptation during systole, without disturbing the subvalvular and annular function, preserving left ventricular function
4 and seems to be associated with improved functional status and freedom from reoperation.
5 However, most patients treated with the ‘Alfieri stitch’ also needed an annuloplasty. The surgical literature suggests that the absence of a ring is associated with suboptimal results and the frequent need for reoperation in patients with more severe MR.
6 Therefore the technique was used in patients who are not candidates for conventional surgical repair. …