39. What is the Alfieri stitch?

The Alfieri stitch is a surgical technique used to treat severe mitral regurgitation during which a suture was placed between the A2 and P2 segments of the mitral valve. This resulted in two mitral valve orifices. It was shown to significantly reduce the degree of mitral regurgitation, however may result in some degree of mitral stenosis. This is best suited for functional mitral regurgitation from annular dilation. Inserting a clip percutaneously between the A2 and P2 mitral valve leaflet segments has been done successfully, although research to support its use is lacking.