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(Circulation. 2008;117:963-974.)
© 2008 American Heart Association, Inc.

Contemporary Reviews in Cardiovascular Medicine

Evolving Concepts and Technologies in Mitral Valve Repair

Paul W.M. Fedak, MD, PhD; Patrick M. McCarthy, MD; Robert O. Bonow, MD

From Libin Cardiovascular Institute of Alberta (P.W.M.F.), Division of Cardiac Surgery, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada; and Bluhm Cardiovascular Institute, Division of Cardiothoracic Surgery (P.M.M.) and Division of Cardiology (R.O.B.), Northwestern Memorial Hospital, Northwestern University Feinberg School of Medicine, Chicago, Ill.

Correspondence to Patrick M. McCarthy, MD, Co-Director of the Bluhm Cardiovascular Institute, Chief of Cardiothoracic Surgery Division, Heller-Sacks Professor of Surgery in the Feinberg School of Medicine, Northwestern University, Division of Cardiothoracic Surgery, 201 E Huron St, Suite 11-140, Chicago, IL 60611-2908. E-mail pmccart@nmh.org

Key Words: mitral valve • regurgitation • cardiac valves • cardiac surgery

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
Over the past few decades, it has become apparent that mitral valve repair is preferable to mitral valve replacement for the majority of patients undergoing surgery for mitral regurgitation (MR). The advantages of mitral valve repair include low rates of thromboembolism, resistance to endocarditis, excellent late durability reported for as long as 25 years, and no need for anticoagulation in the majority of patients.^1–5 Because of these advantages of repair over replacement, the threshold for performing mitral valve repair has been lowered to include patients with MR who have early symptoms or even those who are asymptomatic, assuming that the chance of successful repair is 90% according to the latest American College of Cardiology/American Heart Association guidelines.^6,7

Recently, surgeons have evaluated new techniques to further improve mitral valve repair, and cardiologists and surgeons are increasingly interested in the potential for percutaneous approaches to mitral valve repair.⁸ Myxomatous MR affects 1% to 2% of the population and therefore is a common pathology for mitral valve surgery, but the complexity of the operation may be difficult, which leads to generally low rates of repair. In a recent review, only 44.3% of patients in the United States who required mitral valve surgery for MR received a mitral valve repair,⁹ and in the Euro Heart Survey, repair rates were similarly low (46.5%).¹⁰ The goals of mitral repair are to maintain leaflet mobility, remodel the annulus, and allow normal coaptation of the anterior and posterior leaflets.

Recent advances in techniques and new concepts for mitral . . . [Full Text of this Article]

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