Benefits of Annuloplasty
Annuloplasty is considered the gold standard when surgically repairing the mitral valve. The four priniciples that make it effective are:
• Valve shape restoration
• Valve diameter restoration
• Maximal leaflet coaptation
• Prevention of future dilation (stabilization)
The procedure requires open heart surgery to allow a surgical band to be placed around the annulus to tighten and reshape it, bringing the leaflets into alignment. The band eventually endothelializes into the structure providing stability to the valve and to prevent further dilation of the annulus.
The Alfieri Stitch, also known as edge-to-edge mitral valve repair, is another surgical technique in which a suture is placed between the A2 and P2 segments of the mitral valve, essentially tying two leaflets together to reduce regurgitation. The transcatheter edge-to-edge repair technique (TEER) mimics the Alfieri Stitch by clipping leaflets together.
TEER Considerations
While regurgitation is reduced, studies have shown that the absence of an annuloplasty ring is associated with higher repair failure. By only clipping the leaflets, the annulus is left unsupported allowing for future dilation. Another consideration is that edge-to-edge mitral valve repair prevents future treatment options.
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The CathHELIX system incorporates the principles of annuloplasty into a transcatheter approach.
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Belluschi I, Buzzatti N, Castiglioni A, Alfieri O, De Bonis M. The Alfieri’s edge-to-edge technique for mitral valve repair: from a historical milestone of cardiac surgery to the origin of the transcatheter era. Mini-invasive Surg 2020;4:58. http://dx.doi.org/10.20517/2574-1225.2020.
Surgical Technique
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