Mitral Valve Repair

Excerpt

Although the standard of care for mitral valve (MV) pathology due to degenerative changes is surgical repair, patient outcomes depend on multiple factors, including preoperative status, the severity of mitral regurgitation (MR), the technique of repair, and surgeon and center experience. If MV repair is carried out promptly, the operative risk is low, and life expectancy is close to that of similar sex-aged matched controls. In high-risk patients, the choice among surgical, percutaneous, and conservative approaches can be challenging but should have as its basis patient comorbidities and surgical expertise. Mitral valve repair surgery has advantages over mitral valve replacement, although patient-specific factors must be considered. Of note, close to 50% of patients with severe mitral valve pathology are not candidates for surgical intervention due to age or other comorbidities.

Up to 2% to 3% of adults in the United States have mitral valve disease (see Image. Insufficient Mitral Valve). Patients with degenerative pathology who develop symptoms of MR have a poor prognosis, with annual mortality rates of up to 34%. Mitral stenosis (MS), primarily caused by rheumatic heart disease, is commonly treated by percutaneous mitral balloon commissurotomy (PMBC), also called a percutaneous mitral balloon valvotomy, or mitral valve replacement. Repair is usually not feasible in patients with rheumatic mitral disease.

Mitral regurgitation is classified as primary or secondary, depending on whether the lesion is located at the valvular apparatus or due to left ventricular changes, respectively. While severe primary MR still receives treatment with surgical intervention, percutaneous techniques for repair and replacement are also gaining traction. Mitral valve replacement may be considered in patients with MR caused by papillary muscle rupture, degenerative and ischemic MR, or in patients with a failed repair undergoing reoperation.