Article Text

PDF
Mitral valve repair for degenerative mitral valve disease: surgical approach, patient selection and long-term outcomes
  1. Gonçalo F Coutinho1,2,
  2. Manuel J Antunes1,2
  1. 1 Cardiothoracic Surgery, University Hospital and Centre of Coimbra, Coimbra, Portugal
  2. 2 Faculty of Medicine, University of Coimbra, Coimbra, Portugal
  1. Correspondence to Professor Manuel J Antunes, Cardiothoracic Surgery, University Hospital, 3000-075 Coimbra, Portugal; antunes.cct.chuc{at}sapo.pt

Abstract

Mitral valve repair (MVRepair) has become the procedure of choice to correct severe degenerative mitral regurgitation (MR), due to its documented superiority to valve replacement regarding long-term survival, freedom from valve-related adverse events and preservation of left ventricular (LV) function. The refinement of MVRepair techniques has rendered almost all valves (more than 95%) amenable to repair with a 15-year freedom from reoperation of 90%. The concept of ‘centres of excellence for MVRepair’ has emerged, encouraging referring doctors to select the most experienced institutions or individual surgeons to deal with the most complex cases, based on repair volume, appropriate peri-procedural imaging and data regarding expected outcomes (repair, mortality and durability of repair). Based on the good results, operating on asymptomatic patients with severe MR is now widely accepted, prophylactically avoiding the dire consequences of chronic MR, such as LV function deterioration/enlargement, and development of atrial fibrillation and pulmonary hypertension. In reference centres, where the repair rate is over 95% for all types of disease with <1% mortality, it has become standard practice in nearly 50%–60% of all patients submitted to MVRepair. Finally, recent advances in the surgical treatment with the purpose of reducing invasiveness and surgical trauma, through partial sternotomy or mini-thoracotomy (video-assisted with or without robotics), are now being increasingly performed in 20%–30% of centres, claiming comparable results to conventional surgery. In addition, transcatheter technology, particularly the MitraClip, is evolving and treading its way in the treatment of high-risk patients with severe MR, but the results are still short of ideal.

  • Valve disease surgery
  • Mitral regurgitation

Statistics from Altmetric.com

Footnotes

  • Contributors Both authors contributed equaly to this work.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.