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• W2891764095 abstract "We would like to thank Mihos and colleagues [1Mihos C.G. Xydas S. Nappi F. Santana O. Transaortic Alfieri repair for secondary mitral regurgitation: effective and underused (letter).Ann Thorac Surg. 2018; 106: 1264Abstract Full Text Full Text PDF Scopus (4) Google Scholar] for their comments on our article [2Imasaka K.I. Tayama E. Morita S. Toriya R. Tomita Y. Transaortic Alfieri edge-to-edge repair for functional mitral regurgitation.Ann Thorac Surg. 2018; 105: e141-e143Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar]. Given the higher mortality after double mitral and aortic valve operations than after isolated surgical aortic valve replacement, transaortic Alfieri edge-to-edge mitral valve repair (TA-MVr), which involves a short operative time, can be used as a surrogate procedure. However, the perioperatively worsened mitral regurgitation (MR) after TA-MVr is a concern for surgeons. Performing TA-MVr in patients with severe mitral annular calcification (MAC) could result in restricted leaflet motion and stenosis secondary to the progressive narrowing of the mitral annulus because of bulky calcification, possibly caused by hemodynamic instability during the surgical procedure. Mihos and colleagues [1Mihos C.G. Xydas S. Nappi F. Santana O. Transaortic Alfieri repair for secondary mitral regurgitation: effective and underused (letter).Ann Thorac Surg. 2018; 106: 1264Abstract Full Text Full Text PDF Scopus (4) Google Scholar] reported good intermediate outcomes (median follow-up time, 6.5 months) of TA-MVr despite the presence of degenerative mitral calcification in patients [3Mihos C.G. Santana O. Lamelas J. Intermediate results of transaortic edge-to-edge repair of the mitral valve in patients undergoing aortic valve replacement.J Heart Valve Dis. 2014; 23: 91-96PubMed Google Scholar], but the severity or location of calcification was unclear. Moreover, the edge-to-edge technique without mitral ring annuloplasty for patients with severe MAC may provide poor long-term durability with respect to recurrent MR [4De Bonis M. Lapenna E. Pozzoli A. Giacomini A. Alfieri O. Edge-to-edge surgical mitral valve repair in the era of MitraClip: what if the annuloplasty ring is missed?.Curr Opin Cardiol. 2015; 30: 155-160Crossref PubMed Scopus (23) Google Scholar]. Despite the efficacy of TA-MVr for high-risk patients, candidates for TA-MVr should be selected with caution. Management strategies for patients with aortic valve disease and concomitant MR should be determined after assessments of operative risk, MR severity, and likelihood of MR improvement after isolated aortic valve replacement. In a single-center study of transcatheter MVr with MitraClip (Abbott, Santa Clara, CA), Thaden and associates [5Thaden J.J. Malouf J.F. Nkomo V.T. et al.Mitral valve anatomic predictors of hemodynamic success with transcatheter mitral valve repair.J Am Heart Assoc. 2018; 7: e007315Crossref PubMed Scopus (27) Google Scholar] reported that MAC, an increased preoperative mean diastolic gradient between the left atrium and left ventricle, and the use of multiple clips were significant determinants of increased postprocedural mean diastolic gradient. In conclusion, TA-MVr should be performed in selected patients with anatomic features suitable for the application of the edge-to-edge technique. Transaortic Alfieri Repair for Secondary Mitral Regurgitation: Effective and UnderusedThe Annals of Thoracic SurgeryVol. 106Issue 4PreviewWe read the report by Imasaka and colleagues [1] regarding the transaortic edge-to-edge mitral valve repair (TA-MVr) for secondary mitral regurgitation (MR) in patients undergoing aortic valve replacement (AVR) or aortic root/ascending aorta operations and thank the authors for their insight. Full-Text PDF" @default.
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