Asymmetric Alfieri's stitch to correct systolic anterior motion after mitral valve repair

Pereda, Daniel; Topilsky, Yan; Nishimura, Rick A.

doi:10.1016/j.ejcts.2010.08.040

Cited by 10 publications

(5 citation statements)

References 5 publications

(3 reference statements)

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“…However, the durability of the mitral valve after E2E versus a normal mitral valve is not yet clear, especially in younger patients. Inappropriate stitch placement during the E2E procedure not only makes it difficult to correct MR and LVOTO caused by anterior mitral leaflet anterior displacement but also leads to secondary aortic clipping [ 43 ]. Septal myectomy combined with mitral valve extension utilizes an autologous pericardium or bovine pericardial patch to expand and reinforce the mitral valve, which also achieves the goal of eliminating left ventricular outflow tract obstruction and improving mitral regurgitation.…”

Section: Discussionmentioning

confidence: 99%

Septal Myectomy and Subvalvular Repair in Hypertrophic Cardiomyopathy, a Systematic Review and Pooled Analysis

Song,

Wei,

et al. 2023

Rev. Cardiovasc. Med.

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Background: Some patients with hypertrophic obstructive cardiomyopathy (HOCM) still exhibit systolic anterior motion (SAM) and mitral regurgitation (MR) even after undergoing an isolated ventricular septectomy. Currently, there are disputes regarding whether to perform a mitral valve intervention and which type of operation is more effective. Methods: By searching PubMed, Cochrane, Embase, Web of Science, FDA.gov, and ClinicalTrials.gov, as well as other resource databases, we obtained all articles published before December 2022 on ventricular septal myectomy combined with mitral valve intervention for hypertrophic cardiomyopathy. Demographic information and outcome variable data were extracted from 10 screened studies on ventricular septal resection combined with mitral valve repair. The risk of bias was assessed using methodological index for non-randomized studies (MINORS). Student’s t -test was used for comparisons of continuous variables, and the chi-square or Fisher’s exact test was used for dichotomous variables. A total of 692 patients across 10 studies were analyzed. Results: There were 5 (0.7%) deaths in the perioperative period. The average cardiopulmonary bypass time was 64.7 22.2 minutes, and the average follow-up time was 39.6 36.3 months. Compared with baseline levels, the left ventricular outflow tract gradient (83.6 32.2 mmHg vs. 11.0 7.8 mmHg, p 0.01), maximum interventricular septal thickness (22.5 5.1 mm vs. 14.7 5.5 mm, p 0.01), III/IV mitral regurgitation (351/692 vs. 17/675, p 0.01), anterior mitral leaflet (AML)-annulus ratio (0.49 0.14 vs. 0.60 0.12, p 0.01), tenting area (2.72 0.60 vs. 1.95 0.60 , p 0.01), and SAM (181/194 vs. 11/215, p 0.01) were significantly improved. 14 (2.1%) patients were in New York Heart Association functional class III/IV, which was significantly improved compared with the preoperative state (541/692 vs. 14/682, p 0.01). Conclusions: Ventricular septectomy combined with mitral valve repair can be a safe and effective treatment option for patients suffering from HOCM with SAM and severe MR.

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Section: Discussionmentioning

confidence: 99%

Septal Myectomy and Subvalvular Repair in Hypertrophic Cardiomyopathy, a Systematic Review and Pooled Analysis

Song,

Wei,

et al. 2023

Rev. Cardiovasc. Med.

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“…3B). 26) b. Anterior leaflet retention plasty (ALRP) (Fig. 3C) Delmo Walter and Hetzer proposed ALRP and reported the Berlin experience.…”

Section: Anterior Mitral Leaflet (Aml) Plication Of the Amlmentioning

confidence: 99%

Surgical Management for Systolic Anterior Motion (SAM) of the Mitral Valve in Obstructive Hypertrophic Myopathy

Usui

Mutsuga

2022

ATCS

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In patients with obstructive hypertrophic cardiomyopathy, left ventricular outflow tract (LVOT) obstruction can be created by the hypertrophic interventricular septum (IVS) as well as systolic anterior motion (SAM) of the anterior mitral leaflet (AML). Sufficient septal myectomy is a fundamental surgical technique to treat LVOT obstruction, however, direct surgical management for SAM is another key aspect. Besides the hypertrophic IVS, mitral valve, subvalvular apparatus, and papillary muscle may play important role for SAM and several surgical techniques have been proposed to treat SAM in literature. In this review, each surgical technique is classified by the anatomical structure on which the surgical procedure is applied. The AML is the main surgical site and is applied with plication (vertical plication, resection–plication–release strategy), extension (the AML extension, transverse incision of the AML), sutured (edge-to-edge repair, anterior leaflet retention plasty), or traction (floating stitch, papillary muscle-to-anterior annulus stitches, paradoxical stitches, transposition of a directed chorda tendinea to the AML). Height reduction of the posterior mitral valve leaflet and papillary muscle reorientation are other techniques. We should understand theoretical aspects of each technique on correction of anatomical and functional abnormalities of the structure and should apply them under proper indication.

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“…Many resection and non-resection techniques are available to prevent SAM after mitral valve repair. The sliding plasty [6], triangular resection of the anterior leaflet [7], Elliptical excision at base of anterior leaflet [8], plication of the posterior leaflet [9], transposition of secondary chordae into the anterior leaflet [10], Alfieri's edge-to-edge suture [11], asymmetric Alfieri's stitch [12] and Papillary muscle-to-anterior annulus stitches [13] have been described to prevent or correct SAM .…”

Section: Introductionmentioning

confidence: 99%

Paradoxical Artificial Chords: New Technique to Prevent Systolic Anterior Motion Post Mitral Valve Reconstructions

Kassem¹,

Othman²,

Polvani³

2012

J Clin Exp Cardiolog

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We describe In this report, a new and simple technique to prevent SAM after mitral valve repairs, hence two artificial chords are implanted in the edge of anterior leaflet at five and seven o'clock positions, subsequently these are paradoxically anchored to the posterior annulus avoiding the mitral-septal contact or reducing this contact at the level of the tip of anterior leaflet particularly with notable bulging of the ventricular septum into the out-flow tract.

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Asymmetric Alfieri's stitch to correct systolic anterior motion after mitral valve repair

Cited by 10 publications

References 5 publications

Septal Myectomy and Subvalvular Repair in Hypertrophic Cardiomyopathy, a Systematic Review and Pooled Analysis

Septal Myectomy and Subvalvular Repair in Hypertrophic Cardiomyopathy, a Systematic Review and Pooled Analysis

Surgical Management for Systolic Anterior Motion (SAM) of the Mitral Valve in Obstructive Hypertrophic Myopathy

Paradoxical Artificial Chords: New Technique to Prevent Systolic Anterior Motion Post Mitral Valve Reconstructions

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