The Alfieri repair technique for severe mitral regurgitation in Barlow's disease demonstrated durable competence comparable to Neochordae repair, with 2.4% vs 1.2% more-than-moderate MR at 4.2 years.
Cohort
Does the Alfieri repair technique provide comparable durable competence and hemodynamic safety to the Neochordae technique in patients with severe mitral regurgitation due to Barlow's disease?
The Alfieri procedure provides comparable long-term durability and hemodynamic safety to the Neochordae technique for Barlow's disease, while significantly reducing aortic cross-clamp time.
Absolute Event Rate: 2.4% vs 1.2%
p-value: p=0.810
Background: Mitral regurgitation due to Barlow’s disease remains surgically demanding. Despite widespread experience, consensus is lacking on whether the Alfieri repair can serve as a deliberate and durable rather than a rescue strategy in this complex pathology. Methods: We retrospectively analyzed patients undergoing mitral valve repair due to severe mitral regurgitation resulting from Barlow’s disease using either the Alfieri or Neochordae repair techniques. Patients received a uniform semi–rigid annuloplasty ring, while leaflet resection and concomitant coronary or aortic procedures were excluded. Results: Baseline demographics and echocardiography were broadly comparable. Perioperative mortality was 0% in both cohorts, with similarly low rates of major complications. Aortic cross–clamp time was significantly shorter with Alfieri repair (p < 0.001). No relevant postoperative transmitral gradient or systolic anterior motion occurred. At a mean follow–up of 4.2 years, more–than–moderate MR was observed in one patient per group (Alfieri 2.4% vs. Neochordae 1.2%). At 10 years, the cumulative incidence of more–than–moderate mitral regurgitation and redo mitral surgery was similarly low between techniques (p = 0.810 and p = 0.460). Most patients were NYHA class I–II at last follow–up, demonstrating improved functional status. Echocardiography showed left ventricular reverse remodeling without intergroup differences. Conclusions: These data indicate that the Alfieri approach provides durable competence and hemodynamic safety comparable to the Neochordae technique while reducing cross–clamp time, supporting its use as a deliberate strategy rather than a bailout in anatomically suitable valves.
Steiner et al. (Fri,) conducted a cohort in Severe mitral regurgitation resulting from Barlow's disease. Alfieri repair technique vs. Neochordae repair technique was evaluated on More-than-moderate mitral regurgitation at mean follow-up of 4.2 years (p=0.810). The Alfieri repair technique for severe mitral regurgitation in Barlow's disease demonstrated durable competence comparable to Neochordae repair, with 2.4% vs 1.2% more-than-moderate MR at 4.2 years.