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Background: Mitral valve repair with the edge‐to‐edge technique (Alfieri stitch) has been described for over 20 years, yet little is published on late durability and potential risk of mitral stenosis remains controversial. The primary objective of this study is to describe characteristics and late durability of Alfieri stitch in mitral valve repair. Methods: From 2004 to 2019, we reviewed data from our prospectively maintained institutional database on 1175 consecutive patients with degenerative mitral regurgitation (MR) who underwent repair. Patients undergoing concomitant operations were included. Propensity score matching was performed on patients with and without Alfieri stitch to compare clinical (survival and reoperation) and echocardiographic (moderate or severe MR ["moderate or more MR"], severe MR, and mitral stenosis) outcomes up to 10 years. Results: Overall, 1175 patients underwent mitral valve repair; 55.1% (n = 648) received the Alfieri stitch. The median follow‐up was 4.7 (2.0, 8.2) years. Matched patients with and without Alfieri stitch had similar cumulative incidence (CI) of moderate or more MR (24% ± 5% vs. 17% ± 4%, p = 0.2, respectively), severe MR (5% ± 2% vs. 4% ± 2%, p = 0.3), and mitral reoperation (9% ± 3% vs. 2% ± 1%, p = 0.06) with no difference in survival (84% ± 3% vs. 81% ± 3%, p = 0.2). The Alfieri stitch resulted in a slightly higher mean mitral valve gradient (3.9% ± 1.5 mmHg vs. 3.6% ± 1.6 mmHg, p = 0.0003). The CI of mitral stenosis at 10 years was negligible (one patient with Alfieri stitch and two patients without Alfieri stitch). Conclusions: In selected patients with degenerative mitral regurgitation, mitral valve repair with Alfieri stitch is durable with late outcomes comparable with other repair techniques. The Alfieri stitch may be a useful tool in selecting complex mitral pathology with minimal increased incidence of mitral stenosis. Further investigation is needed to delineate best indications for the use of Alfieri stitch. [ABSTRACT FROM AUTHOR]

Background: The durability of surgical repair for degenerative versus ischemic mitral regurgitation (MR) is thought to be markedly different. We, therefore, examined late outcomes and durability for mitral repair in a large cohort of patients receiving a single annuloplasty device. Methods: A total of 749 consecutive patients receiving mitral repair for degenerative mitral regurgitation (DMR) or ischemic mitral regurgitation (IMR) were evaluated from a prospective database. Patients with tricuspid or maze surgery were included. Papillary muscle rupture and mixed valve etiologies were excluded. Outcomes were compared for IMR versus DMR. Results: Patients with DMR were younger and less urgent. Patients with IMR had mean end‐systolic diameter 4.5 ± 1.1 cm. All patients received the same complete semirigid annuloplasty device with median ring size 32 mm for DMR and 24 mm for IMR. New York Heart Association failure class improved from 2.8 to 1.5 (p <.001). Patients with DMR had lower operative mortality (1/384 [0.3%] vs. 26/365 [7%], p <.0001) and shorter length of stay. A 15‐year survival was better with DMR (63% ± 3% vs. 13% ± 2%, p <.001). At 10 years, the incidence of recurrent ≥2+ MR (10% ± 2% vs. 16% ± 2%, p =.16) was not significantly different. Predictors of recurrent ≥2+ MR were female gender (odds ratio [OR]: 3.0 (1.9–4.8, p <.0001), and prior operation (OR: 2.4 [1.3–4.5], p =.02) but not IMR (OR: 1.4 [0.9–2.3], p =.15). Conclusions: In this series, where patients with IMR had relatively preserved ventricular dimensions, the primary determinants of late recurrent MR were female gender and prior operation but not IMR versus DMR. Selected patients with IMR can obtain relatively durable mitral repair despite higher operative risk and lower survival compared to DMR. [ABSTRACT FROM AUTHOR]