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Timing and Patient’s Selection for Surgical Repair of Secondary Mitral Valve Regurgitation

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Secondary Mitral Valve Regurgitation

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Abstract

Secondary mitral valve regurgitation (SMR) is a complex disease involving distortion of the mitral valve component and left ventricular geometry, mainly caused by chronic coronary artery disease. The indication of coronary artery bypass grafting and the severity of regurgitation should guide the decision to intervene. Surgical repair is indicated in patients with left ventricular ejection fraction >30 % undergoing revascularization and severe mitral regurgitation, as it should be considered in moderate regurgitation, especially if a high likelihood of reparability or a significant dynamic component is documented. In patients without a clear indication of revascularization, the assessment of myocardial viability and coronary status is mandatory. Symptomatic patients with severe mitral regurgitation, left ventricular ejection fraction less than 30 % and option for revascularization with evidence of viability should benefit from repair. In contrast, symptomatic patients with severe mitral regurgitation and left ventricular ejection fraction >30 %, but without possibility of revascularization, should be operated only if they remain symptomatic despite optimal medical treatment and present low comorbidity. For others, medical treatment or even cardiac transplantation is preferred. However, thesurvival benefit of mitral valve repair compared to revascularization alone has not been demonstrated in randomized studies and thus controversy according to optimal therapy persists. Revascularization alone is generally not sufficient to adequately address moderate-severe mitral regurgitation and chronic functional regurgitation following previous surgery is associated with worse prognosis, justifying the addition of a mitral valve procedure. However, the choice of ideal procedure remains litigious. Even if complications related to mitral valve replacement are avoided with repair, this may be counterbalanced by the high rate of persistent/recurrent mitral regurgitation, which may be anticipated using comprehensive preoperative echocardiography.

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Authors and Affiliations

  1. Department of Cardiology, Heart Valve Disease Clinic, CHU Sart Tilman, University of Liège, Liège, Belgium

    Julien Magne PhD, Christine Henri MD & Patrizio Lancellotti MD, PhD

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  1. Julien Magne PhD
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  2. Christine Henri MD
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  3. Patrizio Lancellotti MD, PhD
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Correspondence to Patrizio Lancellotti MD, PhD .

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Editors and Affiliations

  1. GVM Care and Research Group, University of Palermo, Palermo, Italy

    Khalil Fattouch

  2. CHU Sart Tilman, University of Liège, Liège, Belgium

    Patrizio Lancellotti

  3. Hammersmith Hospital, Imperial College of London, London, United Kingdom

    Gianni D. Angelini

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Magne, J., Henri, C., Lancellotti, P. (2015). Timing and Patient’s Selection for Surgical Repair of Secondary Mitral Valve Regurgitation. In: Fattouch, K., Lancellotti, P., Angelini, G. (eds) Secondary Mitral Valve Regurgitation. Springer, London. https://doi.org/10.1007/978-1-4471-6488-3_7

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  • DOI: https://doi.org/10.1007/978-1-4471-6488-3_7

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