Timing of intervention for chronic MR
| Stage | ACC/AHA 2014 | ESC/EACTS 2012 | |
|---|---|---|---|
| Class I—MV surgery is recommended in patients with | |||
| D | Symptomatic chronic severe primary MR and LV EF >30% (ESC adds LV ESD <55 mm) | I (B) | I (B) |
| C2 | Asymptomatic chronic severe primary MR and LV dysfunction (LV EF 30–60% and/or LV ESD ≥40 mm) (ESC uses LV ESD ≥45 mm) | I (B) | I (B) |
| C2 -D | MV repair is recommended in preference to MVR for chronic severe primary MR limited to the posterior leaflet | I (B) | I (C) |
| C2 -D | MV repair is recommended in preference to MVR for chronic severe primary MR involving the anterior leaflet or both leaflets when a successful and durable repair can be accomplished | I (B) | I (C) |
| C | Concomitant MV repair or replacement in patients with chronic severe primary MR undergoing cardiac surgery for other indications | I (B) | |
| Class IIa—MV repair is reasonable in patients with | |||
| C1 | Asymptomatic chronic severe primary MR with preserved LV function (LV EF>60% and LV ESD <40 mm) with:
| IIa (B) | IIa (B) flail leaflet and ESD ≥40 mm IIb (C) for LAE or exertional PASP ≥60 |
| C1 | Asymptomatic chronic severe non-rheumatic primary MR and preserved LV function with high likelihood of durable repair with new onset of AF or resting pulmonary hypertension (PASP>50 mm Hg) | IIa (B) | IIa (C) |
| B | Chronic moderate primary MR if undergoing cardiac surgery for other indications | IIa (C) | – |
| CLASS IIb—intervention may be considered in patients with | |||
| D | MV surgery may be considered in symptomatic patients with chronic severe primary MR and LV EF ≤30% | IIb (C) | IIa (C) high likelihood repair or IIb (C) if low |
| D | Rheumatic mitral valve disease when surgical treatment is indicated if a durable and successful repair is likely or if the reliability of long-term anticoagulation management is questionable | IIb (B) | – |
| D | Transcatheter MV repair for severely symptomatic chronic severe primary MR who have a reasonable life expectancy but a prohibitive surgical risk because of severe comorbidities | IIb (B) | – |
| CLASS III—MVR should NOT be performed in patients with | |||
| Isolated severe primary MR limited to less than one half of the posterior leaflet unless MV repair has been attempted and was unsuccessful | III (Harm) (B) | – | |
AF, atrial fibrillation; ESD, end-systolic dimension; MR, mitral regurgitation; MV, mitral valve; MVR, mitral valve replacement; PASP, pulmonary artery systolic pressure.