Mitral valve repair: better than replacement
- Centro de Cirurgia Cardiotorácica, Hospital da Universidade, Coimbra, Portugal
- Correspondence to:
Professor Manuel J Antunes
Centro de Cirurgia Cardiotorácica, Hospitais da Universidade, 3049 Coimbra Codex, Portugal;
For the majority of surgeons, mitral valve repair has become the method of choice for surgical correction of mitral regurgitation. However, the feasibility of repair depends not only on the pathology but also on the experience of the surgeon and/or team. Success rates may reach almost 100% in the most common form of isolated prolapse of the middle scallop of the posterior leaflet. Nevertheless, mitral repair is still subject to a pronounced, sometimes painful, learning curve. The durability of the repair also depends on the type of pathology and on many other factors, including the technique used.
Since its inception in the 1970s, the techniques of mitral valve repair have been the subject of many modifications and improvements which have made it a more predictable and reproducible method. One area where much improvement was made was ischaemic regurgitation, which was initially considered refractory to repair and for which there is now a growing experience and much improved results. Also, advancements have occurred in the treatment of regurgitation related to cardiomyopathy, previously considered a contraindication for repair. By contrast, repair for rheumatic disease still carries the worst results, although the characteristics of the usually underdeveloped and young population may still make it preferable to mitral valve replacement.
In this work, we analyse the state of the art of mitral valve repair and its results according to our experience and in the light of recent reports.
MITRAL VALVE REPAIR: ACCEPTED ALTERNATIVE TO PROSTHETIC REPLACEMENT
After an initial period of distrust, in the late 1970s and early 1980s, when it was developed mainly through the efforts of Carpentier,1 Duran,2 and others, mitral valve repair has since become a generally accepted alternative to prosthetic replacement for surgical treatment of virtually all forms of mitral valve disease; indeed, most surgeons now recognise its superiority, in terms of both early and late …