Trans-aortic Alfieri stitch at the time of septal myectomy for hypertrophic obstructive cardiomyopathy

Abstract

Trans-aortic Alfieri stitch placement during septal myectomy is feasible in most cases as an additional tool to improve MR and minimize SAM. This technique may have a role in addressing mitral disease, such as a long anterior leaflet or fibrotic mitral valve, at the time of myectomy without the need for left atriotomy for mitral exposure.

The Use of MitraClip for Symptomatic Patients with Hypertrophic Obstructive Cardiomyopathy

“…There are now a few studies that have looked at the concurrent treatment of mitral valve pathology in addition to surgical myectomy [2,11,12]. A recent study reported on the use of an Alfieri stitch at the time of septal reduction surgery in 24 HOCM patients [12].…”

“…A recent study reported on the use of an Alfieri stitch at the time of septal reduction surgery in 24 HOCM patients [12]. An Alfieri stitch is a surgical procedure during which the middle portions of the anterior and posterior mitral leaflets are plicated with a suture, similar to a MitraClip plication.…”

Early and medium-term outcomes of Alfieri mitral valve repair in the management of systolic anterior motion during septal myectomy

“…This study, using the trans aortic Alfieri repair technique, reported an encouraging early experience of an Alfieri repair in HCM, but had limited follow‐up data. A study by Shah et al, focused on perioperative complications following trans aortic Alfieri repair in 24 patients with LVOTO in HCM with short, limited follow‐up data with one early mortality from a ventricular septal defect (VSD) . Recently Obadia et al, reported outcomes in 22 patients with a trans aortic Alfieri repair after SM with shorter follow‐up and only early echocardiographic data .…”

An Evolution of Management in Hypertrophic Cardiomyopathy: Myectomy, Alcohol Septal Ablation, Mitral Valve Replacement, MitraClip

“…More recently, the Alfieri stitch (edge-to-edge repair with placement of a suture between the anterior and posterior mitral valve leaflets) was used in 23 patients with HCM at the time of septal myectomy [16]. The use of an Alfieri stitch resulted in a decrease in the LVOT pressure gradient, significant decrease in the severity of mitral regurgitation, and marked symptomatic improvement.…”