The cardiologist’s way to do the Alfieri stitch: transcatheter mitral valve edge-to-edge repair revisited

More than 10% of people 75 years and older suffer from severe symptomatic mitral regurgitation (1). This number even increases with increasing age. Whereas mitral valve repair and replacement is the gold standard in younger patients with normal left ventricular function, surgical risk dramatically increases with increasing age and impairment of left ventricular function. Fifty percent and more patients with severe symptomatic mitral valve regurgitation are denied surgery (2) due to high perioperative mortality, unsatisfactory longterm survival, and questionable benefit on quality of life (3), especially in older patients.