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mitral valve surgery

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 Epidemiology: - 37% of patients undergoing mitral valve surgery have mitral valve repair; 63% have mitral valve replacement - comorbidties (congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, atrial fibrillation) more prevalent in patients undergoing mitral valve replacement compared with mitral valve repair. Special laboratory: - preoperative coronary angiography in at risk* patients with severe, symptomatic mitral regurgitation referred for elective mitral valve surgery * at risk = men > 40 years of age, postmenopausal women, women > 40 years of age with cardiac risk factors [2,4] Complications: - operative mortality is 7.1% - 3.9% for mitral valve repair - 8.9% for mitral valve replacement Management: - mitral valve surgery 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 - 37% for mitral valve replacement

Related

mitral valve

Specific

mitral valve repair mitral valve replacement (MVR)

General

cardiac surgery (heart surgery)

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. NEJM Knowlege+. February 21, 2017. http://knowledgeplus.nejm.org/question-of-week/153/
  3. Verma S and Mesana TG. Mitral-valve repair for mitral-valve prolapse. N Engl J Med 2009 Dec 4; 361:2261 PMID: 19955526 http://www.nejm.org/doi/full/10.1056/NEJMct0806111
  4. Nishimura RA, Otto CM, Bonow RO et al 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. PMID: 24589853 Free full text
  5. Otto CM et al 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;143:e00 PMID: 33332150 https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000923