Mitral valve repair vs replacement. Current recommendations and long-term results

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair
• Mitral Valve Disease

Background:

• Current techniques allow repair of most mitral valve components, with limitations in extensive leaflet tissue loss.
• Myxomatous valves with redundant leaflets are particularly amenable to repair.
• Repair of rheumatic mitral valves is possible but requires strict patient selection criteria.

Purpose of the Study:

• To review the current state and limitations of mitral valve repair techniques.
• To identify ideal candidates and contraindications for mitral valve repair.
• To discuss the challenges and outcomes associated with specific types of mitral regurgitation repair.

Main Methods:

• Review of existing surgical techniques for mitral valve repair.
• Analysis of patient selection criteria for successful mitral valve repair.
• Discussion of repair strategies for various mitral regurgitation etiologies, including myxomatous, rheumatic, endocarditis, and ischemic types.

Main Results:

• Myxomatous valves are ideal for repair; rheumatic valves require careful selection, avoiding leaflet loss, thickening, or calcification.
• Subvalvular apparatus abnormalities are manageable with reconstruction using PTFE.
• Endocarditis cases can be repaired with débridement and patching; Type I ischemic mitral regurgitation remains challenging.
• Repairs in patients with small annuli, multiple leaflet defects, or small left ventricles have lower success rates and higher risk of SAM.

Conclusions:

• Successful mitral valve repair hinges on accurate diagnosis, patient selection, and precise surgical execution.
• While significant advancements exist, certain conditions like extensive leaflet loss and Type I ischemic mitral regurgitation present ongoing challenges.
• Optimizing outcomes requires a thorough understanding of the underlying pathology and tailoring repair strategies accordingly.