A Durable Surgical Option in Degenerative Mitral Regurgitation
This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Article, see p 410
Mitral regurgitation (MR) has a prevalence of 2% in the general population, and prevalence rises steeply as a function of age.1 Primary MR is a result of pathology affecting 1 or more components of the mitral valve apparatus, whereas secondary MR is a consequence of annular dilatation and geometric distortion of the subvalve apparatus secondary to left ventricular remodeling and dyssynchrony. Secondary MR is generally associated with cardiomyopathy or coronary artery disease.
Primary MR is usually a consequence of degenerative disease and has a prolonged bimodal clinical course characterized by an initial prolonged asymptomatic phase (when left ventricular volume overload is compensated for by progressing dilatation) and a later symptomatic phase accompanied by left ventricular decompensation and adverse outcome. There is no effective medical therapy, and although β-blockers and angiotensin-converting enzyme inhibitors may palliate symptoms once heart failure has developed, they should not be used to postpone the need for surgery.
Treatment algorithms have been redefined in recent years as a result of the excellent outcomes of surgical repair.2 International guidelines now recommend risk stratification and earlier intervention when the probability of durable repair is high and surgery can be undertaken by experienced teams with high repair rates and low operative mortality and morbidity.3,4 Nevertheless, the advantages of this preemptive approach in comparison with “watchful waiting” in the setting of a dedicated valve clinic remain the source of debate.
Effective and durable mitral valve repair can be achieved in >95% of …