Mitral Regurgitation: Current Treatment Options and Their Selection

Abstract

Mitral regurgitation (MR) is a mechanically complex hemodynamic abnormality of various etiologies that, if untreated, leads to myocardial dysfunction, heart failure, and sudden death. Unless hemodynamically severe, MR is not a major risk factor for debility and death. However, even more modest MR may impact on longevity and may create risk for thromboembolic and infectious sequelae. Currently, therapy for severe MR is surgical valve replacement or repair. When MR is not secondary to ischemic sequelae, generally accepted indications for surgery include any symptoms, left ventricular or right ventricular dysfunction or left ventricular geometric variations that reach defined levels of prognostic concern, or development of atrial fibrillation. However, low perioperative risk of repair causes some to urge surgery for severe MR irrespective of other findings. Similar controversy confounds decisions about mitral valve surgery during coronary artery bypass grafting when MR is a sequel of ischemic disease. Drug treatment has not altered MR outcome, although drugs can mitigate symptoms if surgery is contraindicated by intercurrent disease. There is no basis for prophylactic drug treatment to preserve myocardial function in asymptomatic patients.