mitral valve surgery
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Epidemiology
- 37% of patients undergoing mitral valve surgery have mitral valve repair; 63% have mitral valve replacement
- comorbidties (congestive heart failure, chronic kidney disease, chronic obstructive pulmonary disease, atrial fibrillation) more prevalent in patients undergoing mitral valve replacement compared with mitral valve repair.
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
- preoperative coronary angiography in at risk* patients with severe, symptomatic mitral regurgitation referred for elective mitral valve surgery
* at risk = men > 40 years of age, postmenopausal women, women > 40 years of age with cardiac risk factors[2][4]
Complications
- operative mortality is 7.1%
- 3.9% for mitral valve repair
- 8.9% for mitral valve replacement
Management
- mitral valve surgery should not be delayed or denied based on age alone
- mitral valve repair rather than mitral valve replacement is preferred unless clinically or anatomically contraindicated[1]
- prognosis: estimated 10-year survival
- 54% for mitral valve repair
- 37% for mitral valve replacement
More general terms
More specific terms
Additional terms
References
- ↑ 1.0 1.1 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 - ↑ 2.0 2.1 NEJM Knowlege+. February 21, 2017. http://knowledgeplus.nejm.org/question-of-week/153/
- ↑ Verma S and Mesana TG. Mitral-valve repair for mitral-valve prolapse. N Engl J Med 2009 Dec 4; 361:2261 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/19955526 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMct0806111
- ↑ 4.0 4.1 Nishimura RA, Otto CM, Bonow RO et al 2014 AHA/ACC Guideline 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. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24589853 Free full text
- ↑ Otto CM et al 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease. A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021;143:e00 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33332150 https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000000923