Zwischenberger Brittany A, Gaca Jeffrey G, Carr Keith, Wang Andrew, Glower Donald D
Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA.
Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA.
Innovations (Phila). 2025 Mar-Apr;20(2):167-174. doi: 10.1177/15569845251325260. Epub 2025 May 3.
The Alfieri stitch is a mitral repair technique that can easily be applied in less invasive approaches to the mitral valve. However, the Alfieri stitch is seldom used and has raised concerns about producing mitral stenosis or recurrent regurgitation.
A total of 1,134 consecutive patients undergoing repair of degenerative mitral regurgitation via right minithoracotomy from 1997 to 2019 were examined from a prospectively maintained database. Propensity score matching was performed on patients with and without Alfieri stitch.
The Alfieri stitch was used in 697 of 1,134 patients (53%) with annuloplasty in all patients. Patients receiving the Alfieri stitch had more flail leaflet ( = 0.001), larger rings ( < 0.001), more chordal replacement ( < 0.001), and more cleft closure ( < 0.001). In 201 matched patient pairs, Alfieri patients did not differ significantly in baseline characteristics or procedure performed other than the Alfieri stitch. Matched patients with Alfieri stitch had similar clamp and pump times and no difference in postoperative course. Matched patients with Alfieri stitch had only slightly higher mean postoperative gradient (4.0 ± 1.5 vs 3.2 ± 1.3 mm Hg, < 0.001). At 10 years, matched patients with Alfieri stitch showed nonsignificant differences in survival ( = 0.5), cumulative incidence of severe mitral regurgitation (5% ± 3% vs 3% ± 3%, = 0.3), and moderate or more mitral regurgitation (17% ± 4% vs 12% ± 4%, = 0.8) but more mitral reoperation at 10 years (6% ± 3% vs 1% ± 1%, = 0.02).
The Alfieri stitch can be applied via right minithoracotomy to repair a wide variety of degenerative mitral pathology with minimally higher mitral gradient and a late trend toward increased mitral reoperation at 10 years.
阿尔菲里缝合术是一种二尖瓣修复技术，可轻松应用于二尖瓣的微创入路。然而，阿尔菲里缝合术很少使用，且引发了对产生二尖瓣狭窄或复发性反流的担忧。
从一个前瞻性维护的数据库中检查了1997年至2019年期间通过右胸小切口连续接受退行性二尖瓣反流修复的1134例患者。对使用和未使用阿尔菲里缝合术的患者进行倾向评分匹配。
1134例患者中有697例（53%）使用了阿尔菲里缝合术，所有患者均进行了瓣环成形术。接受阿尔菲里缝合术的患者有更多的连枷样瓣叶（P = 0.001）、更大的瓣环（P < 0.001）、更多的腱索置换（P < 0.001）和更多的瓣裂闭合（P < 0.001）。在201对匹配的患者中，除了阿尔菲里缝合术外，接受阿尔菲里缝合术的患者在基线特征或所进行的手术方面没有显著差异。匹配的接受阿尔菲里缝合术的患者有相似的夹闭和体外循环时间，术后病程无差异。匹配的接受阿尔菲里缝合术的患者术后平均梯度仅略高（4.0±1.5 vs 3.2±1.3 mmHg，P < 0.001）。在10年时，匹配的接受阿尔菲里缝合术的患者在生存率（P = 0.5）、严重二尖瓣反流的累积发生率（5%±3% vs 3%±3%，P = 0.3）和中度或更严重二尖瓣反流（17%±4% vs 12%±4%，P = 0.8）方面无显著差异，但在10年时二尖瓣再次手术更多（6%±3% vs 1%±1%，P = 0.02）。
阿尔菲里缝合术可通过右胸小切口应用于修复多种退行性二尖瓣病变，二尖瓣梯度略高，且10年时有二尖瓣再次手术增加的晚期趋势。
