Percutaneous mitral valve repair using the edge-to-edge technique in a high-risk population

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 function4 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. …