Edge-to-edge Alfieri technique for mitral valve repair: which indications?

PURPOSE OF REVIEW: To outline the current indications to the edge-to-edge technique for mitral valve repair. Indeed, after its introduction in the early 1990s, criteria for appropriate patient selection and technical issues of this approach have been progressively refined over the years and are now rather standardized. RECENT FINDINGS: The long-term results (up to 17 years) of this approach in the setting of degenerative mitral regurgitation with bileaflet and anterior leaflet prolapse have been recently reported and confirm the important role of this method in the surgical armamentarium of mitral valve reconstruction. In addition, recent data support the use of this method in new special situations and settings (systolic anterior motion prevention/treatment, congenital atrioventricular valve incompetence, as a 'rescue' procedure in case of suboptimal conventional repair). SUMMARY: In mitral regurgitation competence of the mitral valve can be restored by using a 'functional' rather than a conventional 'anatomical' repair. This 'functional' repair is realized by means of the edge-to-edge technique that consists in suturing together the facing portions of the anterior and posterior mitral valve leaflets in correspondence to the location of the regurgitant jet. The edge-to-edge technique was introduced in the early 1990s and has provided a useful contribution to the surgical armamentarium of mitral valve repair. Appropriate indications and awareness of the important technical aspects of the procedure are prerequisites for a good outcome. In this review the present role of the edge-to-edge repair, particularly in terms of indications and contraindications, will be outlined and discussed.