Status of mitral valve surgery

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Disease
• Surgical Innovation

Background:

• Mitral valve regurgitation historically led to valve replacement.
• Valve repair is now recognized as superior to replacement for long-term patient outcomes.
• Repair avoids complications associated with artificial valves and anticoagulation therapy.

Purpose of the Study:

• To review the historical evolution of mitral valve repair.
• To outline current, favored mitral valve repair techniques.
• To emphasize the importance of understanding disease processes and techniques for durable repairs.

Main Methods:

• Review of historical trends in mitral valve surgery.
• Description of current, favored mitral valve repair techniques.
• Emphasis on knowledge of disease pathology and surgical skills.

Main Results:

• Chordal replacement with polytetrafluoroethylene (ePTFE) sutures is a reproducible technique for anterior leaflet repair.
• Quadrangular resection or sliding repair effectively addresses most posterior leaflet problems.
• Mitral valve repair demonstrates superior long-term outcomes compared to valve replacement.

Conclusions:

• Mitral valve surgery has evolved over 50 years, shifting from replacement to repair.
• Durable mitral valve repair is achievable with detailed knowledge and current techniques.
• Repair offers better long-term results and avoids artificial valve complications.