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mitral valve repair

Indications: 1) mitral stenosis: a) mitral valve area < 1 cm2/m2 (body surface area) b) severe symptoms c) recurrent systemic thromboembolism d) pulmonary hypertension e) valvuloplasty may be an alternative to mitral valve replacement 2) mitral regurgitation* a) symptomatic or progressive increase in LV size - LV end diastolic dimension > 4.5 cm b) decline in LV systolic function c) transcatheter repair in patients with heart failure & secondary mitral regurgitation [5] * transcatheter mitral valve repair improves survival in high surgical risk patients with severe mitral regurgitation [2] * mitral valve repair for moderate MR during CABG reduces MR at 12 months, but does not improve reverse LV remodeling or improve survival or quality of life [3] * LVAD more likely to prolong life tham mitral valve repair in patients with systolic heart failure (LVEF 20%) & moderate mitral regurgitation [8] Epidemiology: - 37% of patients undergoing mitral valve surgery have mitral valve repair; 63% have mitral valve replacement Special laboratory: - preoperative cardiac catheterization with coronary angiography for patients with cardiac risk factor(s) [11] Procedure: - MitraClip device FDA-approved 2013 for patients with heart failure [7] - transcatheter edge-to-edge repair (TEER) with MitraClip for patients with heart failure & secondary mitral regurgitation [10] Complications: - operative mortality is 3.9% for mitral valve repair - transcatheter mitral valve repair - mortality: 2.7% in-hospital, 5% at 30 days, 26% at 1 year [4] - rehospitalization within 1-year for heart failure in 20% [4] Management: - mitral valve repair should not be delayed or denied based on age alone - mitral valve repair rather than mitral valve replacement is preferred unless clinically or anatomically contraindicated [1] - prognosis: estimated 10-year survival = 54% for mitral valve repair Notes: - procedure success with transcatheter mitral valve repair improves with experience (after 1st 50 procedures) [9]

Related

mitral valve mitral valve replacement (MVR)

Specific

transcatheter mitral valve repair; transcatheter mitral edge-to-edge repair (TEER)

General

mitral valve surgery cardiac valve repair

References

  1. Vassileva CM et al. Long term survival of patients undergoing mitral valve repair and replacement: A longitudinal analysis of Medicare fee-for- service beneficiaries. Circulation 2013 Apr 8 PMID: 23569153 http://circ.ahajournals.org/content/early/2013/04/08/CIRCULATIONAHA.113.002200 - Rao RK and Foster E. Rethinking mitral valve surgery during the golden years. Circulation 2013 Apr 8 PMID: 23569152 http://circ.ahajournals.org/content/early/2013/04/08/CIRCULATIONAHA.113.002574
  2. Swaans MJ et al. Survival of transcatheter mitral valve repair compared with surgical and conservative treatment in high-surgical-risk patients. JACC Cardiovasc Interv 2014 Aug; 7:875. PMID: 25147032 - Bonow RO. The saga continues: Does mitral valve repair improve survival in secondary mitral regurgitation? JACC Cardiovasc Interv 2014 Aug; 7:882 PMID: 25147033
  3. Smith PK et al. Surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med 2014 Nov 18 PMID: 25405390 http://www.nejm.org/doi/full/10.1056/NEJMoa1410490
  4. Sorajja PSorajja P, Vemulapalli S, Feldman T et al. Outcomes with transcatheter mitral valve repair in the United States: An STS/ACC TVT registry report. J Am Coll Cardiol 2017 Nov 7; 70:2315. (http://dx.doi.org/10.1016/j.jacc.2017.09.015 PMID: 29096801 - Bolling SF. First TMVR enters U.S. market as a therapy, and a gateway. J Am Coll Cardiol 2017 Nov 7; 70:2328 PMID: 29096802
  5. Stone GW, Lindenfeld J, Abraham WT Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med 2018 Sept 23. PMID: 30280640 Free Article https://www.nejm.org/doi/full/10.1056/NEJMoa1806640
  6. Sorajja P, Mack M, Vemulapalli S et al Initial Experience With Commercial Transcatheter Mitral Valve Repair in the United States. J Am Coll Cardiol. 2016 Mar 15;67(10):1129-1140. PMID: 26965532 Free Article
  7. FDA News Release. March 14, 2019 FDA approves new indication for valve repair device to treat certain heart failure patients with mitral regurgitation. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm633479.htm
  8. Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
  9. Chhatriwalla AK et al. Operator experience and outcomes of transcatheter mitral valve repair in the United States. J Am Coll Cardiol 2019 Dec 17; 74:2955. PMID: 31568867 - Resor CD. The TMVr operator volume and outcome relationship: More is more. J Am Coll Cardiol 2019 Dec 17; 74:2966 PMID: 31568870
  10. Mack MJ, Lindenfeld J, Abraham WT et al. 3-year outcomes of transcatheter mitral valve repair in patients with heart failure. J Am Coll Cardiol 2021 Mar 2; 77:1029. PMID: 33632476 https://www.sciencedirect.com/science/article/abs/pii/S0735109720382656 - Depta JP, Bhatt DL. Crossover in COAPT: Does this extend the reach of TMVr for treating functional MR? J Am Coll Cardiol 2021 Mar 2; 77:1041 PMID: 33632477 https://www.sciencedirect.com/science/article/abs/pii/S0735109721000036
  11. NEJM Knowledge+