Clinical situation | Mitral valve surgery (ESC guidelines 2007) |
Patients with severe IMR (ERO ⩾20 mm2) | |
Ruptured papillary muscle due to acute MI | Immediate |
LV ejection fraction ⩾30% undergoing CABG | Recommended (IC) |
LV ejection fraction <30% and option for CABG | Reasonable if symptomatic (IIaC) |
LV ejection fraction ⩾30%, no option for CABG | To consider if symptomatic and low morbidity (IIbC) |
Patients with moderate IMR (ERO <20 mm2) | |
Undergoing CABG | Reasonable if repair is feasible (IIaC) |
No option for CABG or undergoing PCI | Uncertain (“a priori not”) |
Patients with trace IMR | |
Undergoing CABG | Not recommended |
CABG, coronary bypass grafting; ERO, effective regurgitant orifice; ESC, European Society of Cardiology; LV, left ventricular; MI, myocardial infarction; PCI, percutaneous coronary intervention.