Mitral valve regurgitation surgery
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
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Indications for Surgery in Chronic Mitral Regurgitation
Indications for surgery for chronic mitral regurgitation include signs of left ventricular dysfunction. These include a left ventricular ejection fraction (LVEF) of less than 60% and a left ventricular end systolic dimension (LVESD) of greater than 45 mm.
| Symptoms | LV EF | LVESD |
|---|---|---|
| NYHA II - IV | > 60 percent | < 45 mm |
| Asymptomatic or symptomatic | 50 - 60 percent | ≥ 45 mm |
| Asymptomatic or symptomatic | < 50 percent or ≥ 45 mm | |
| Pulmonary artery systolic pressure ≥ 50 mmHg | ||
Factors influencing the timing of surgery for MR include symptoms, LV EF, LV end-systolic dimension, atrial fibrillation, and pulmonary hypertension. In most situations, MV repair is the operation of choice for those patients with suitable MV anatomy.
Specific Patient Populations
Severe MR and Any Symptoms
An operation is indicated for most patients with severe MR and any symptoms.
Severe MR and No Symptoms
There is controversy regarding the timing of surgery in the asymptomatic patient with severe MR and normal LV function. If MV repair can be performed with a high degree of success and the operative risk is low, it is reasonable to proceed with surgery to prevent irreversible LV dysfunction from occurring. However, this “early” operation should only be performed at centers in which there is a high likelihood of successful MV repair because of their demonstrated expertise in this area.
Asymptomatic Patients with Mild to Moderate LV Dysfunction
An operation is also indicated in asymptomatic patients who demonstrate mild to moderate LV dysfunction (an LVEF of 30% to 60%) and a left ventricular end-systolic dimension 40 to 55 mm).
Severe LV Dysfunction with a Dilated Ventricle
The patient with severe LV dysfunction (an LVEF < 30% and/or a left ventricular end-systolic dimension greater than 55 mm poses a higher risk but may undergo surgery if chordal preservation is likely.
References
- ↑ "ACC/AHA guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association. Task Force on Practice Guidelines (Committee on Management of Patients with Valvular Heart Disease)". Journal of the American College of Cardiology. 32 (5): 1486–588. 1998. PMID 9809971. Retrieved 2011-03-16. Unknown parameter
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