mitral valve replacement (MVR)
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Introduction
Also see mitral valve surgery
Indications
- mitral stenosis:
- mitral valve area < 1 cm2/m2 (body surface area)
- severe symptoms
- recurrent systemic thromboembolism
- pulmonary hypertension
- valvuloplasty may be an alternative to mitral valve replacement
- mitral regurgitation
- symptomatic or progressive increase in LV size
- decline in LV systolic function
Diagnostic procedures
- cardiac catheterization with coronary angiography in patients at risk for coronary artery disease
Procedure
- bioprosthetic valve vs mechanical mitral valve replacement
- mechanical prosthetic valves are associated with lower risk of reoperation but greater risk of bleeding or stroke[4]*
- no significant survival difference at 15 years*
- mortality benefit for mechanical valve vs bioprosthetic valve persists until age 70 years[7]
* patients aged 50-69 years[4]
- transcatheter MVR with a balloon-expandable valve prosthesis for degenerated mitral bioprostheses & failed annuloplasty rings is a less invasive alternative to repeat surgery[5][6]
Complications
- operative mortality 5-15% in the elderly[2]
- operative mortality is 8.9% for mitral valve replacement vs 3.9% for mitral valve repair[3]
- severe mitral annular calcification makes transcatheter MVR more challenging[5]
- procedural complications (20%)
- left ventricular outflow tract obstruction (9%)
- valve embolization (6%)
- stroke occurred (7%)
- conversion to open surgery (6%)
- periprocedural mortality by 30 days (30%)[5]
- procedural complications (20%)
Management
- mitral valve replacement should not be delayed or denied based on age alone[3]
- mitral valve repair rather than mitral valve replacement is preferred unless clinically or anatomically contraindicated[3]
- prognosis: estimated 10-year survival
- 37% for mitral valve replacement
- lifetime anticoagulation
- rivaroxaban for atrial fibrillation & bioprosthetic mitral valve[8]
More general terms
More specific terms
Additional terms
References
- ↑ Manual of Medical Therapeutics, 28th ed, Ewald & McKenzie (eds), Little, Brown & Co, Boston, 1995, pg 126
- ↑ 2.0 2.1 Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
- ↑ 3.0 3.1 3.2 3.3 Vassileva CM et al. Long term survival of patients undergoing mitral valve repair and replacement: A longitudinal analysis of Medicare fee-for- service beneficiaries. Circulation 2013 Apr 8 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23569153 <Internet> http://circ.ahajournals.org/content/early/2013/04/08/CIRCULATIONAHA.113.002200
Rao RK and Foster E. Rethinking mitral valve surgery during the golden years. Circulation 2013 Apr 8 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23569152 <Internet> http://circ.ahajournals.org/content/early/2013/04/08/CIRCULATIONAHA.113.002574 - ↑ 4.0 4.1 4.2 Chikwe J et al. Survival and outcomes following bioprosthetic vs mechanical mitral valve replacement in patients aged 50 to 69 years. JAMA 2015 Apr 14; 313:1435 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25871669
- ↑ 5.0 5.1 5.2 5.3 Guerrero M et al. Transcatheter mitral valve replacement in native mitral valve disease with severe mitral annular calcification: Results from the first multicenter global registry. JACC Cardiovasc Interv 2016 Jul 11; 9:1361 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27388824
- ↑ 6.0 6.1 Yoon SH, Whisenant BK, Bleiziffer S et al. Transcatheter mitral valve replacement for degenerated bioprosthetic valves and failed annuloplasty rings. J Am Coll Cardiol 2017 Aug 29; 70:1121. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28838360
Webb JG, Cheung AW, Dvir D. Transcatheter mitral valve replacement when mitral surgery fails: 10 years later. J Am Coll Cardiol 2017 Aug 29; 70:1132. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28838361 - ↑ 7.0 7.1 Goldstone AB, Chiu P, Baiocchi M et al Mechanical or Biologic Prostheses for Aortic-Valve and Mitral- Valve Replacement. N Engl J Med 2017; 377:1847-1857. November 9, 2017 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29117490 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1613792
- ↑ 8.0 8.1 Guimaraes HP et al. Rivaroxaban in patients with atrial fibrillation and a bioprosthetic mitral valve. N Engl J Med 2020 Nov 14; [e-pub]. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33196155 https://www.nejm.org/doi/10.1056/NEJMoa2029603