Alfieri Repair: This is advised for ischaenlic mitral regurgitation. In the area of prolapse, the anterior and posterior leaflet edges are approximated with one or two mattress sutures (edge to edge repair). If done for prolapse of the middle leaflet the mattress sutures effectively make a double orifice mitral valve, which functions adequately for a period of time.
In babies and children, annuloplasty ring is avoided, as they need further growth of the annulus.
Valves are tested by distending with saline. Previous methods of dynamic testing with the heart beating and left atrium open are given up. Preference is given to TEE Lesling 011 conling off bypass with good systemic pressure. With cannulae not removed, one call go again and do further repair or replacement.