mitral valve repair
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Epidemiology
- 37% of patients undergoing mitral valve surgery have mitral valve repair; 63% have mitral valve replacement
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
- transcatheter repair in patients with heart failure & secondary mitral regurgitation[5]
* transcatheter mitral valve repair improves survival in high surgical risk patients with severe mitral regurgitation[2]
* mitral valve repair for moderate MR during CABG reduces MR at 12 months, but does not improve reverse LV remodeling or improve survival or quality of life[3]
* LVAD more likely to prolong life tham mitral valve repair in patients with systolic heart failure (LVEF 20%) & moderate mitral regurgitation[8]
Diagnostic procedures
- preoperative cardiac catheterization with coronary angiography for patients with cardiac risk factor(s)[11]
Procedure
- MitraClip device FDA-approved 2013 for patients with heart failure[7]
- transcatheter edge-to-edge repair (TEER) with MitraClip for patients with heart failure & secondary mitral regurgitation[10]
Complications
- operative mortality is 3.9% for mitral valve repair
- transcatheter mitral valve repair
- mortality: 2.7% in-hospital, 5% at 30 days, 26% at 1 year[4]
- rehospitalization within 1-year for heart failure in 20%[4]
Management
- mitral valve repair 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
Notes
- procedure success with transcatheter mitral valve repair improves with experience (after 1st 50 procedures)[9]
More general terms
More specific terms
Additional terms
References
- ↑ Jump up to: 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 - ↑ Jump up to: 2.0 2.1 Swaans MJ et al. Survival of transcatheter mitral valve repair compared with surgical and conservative treatment in high-surgical-risk patients. JACC Cardiovasc Interv 2014 Aug; 7:875. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25147032
Bonow RO. The saga continues: Does mitral valve repair improve survival in secondary mitral regurgitation? JACC Cardiovasc Interv 2014 Aug; 7:882 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25147033 - ↑ Jump up to: 3.0 3.1 Smith PK et al. Surgical treatment of moderate ischemic mitral regurgitation. N Engl J Med 2014 Nov 18 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25405390 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1410490
- ↑ Jump up to: 4.0 4.1 4.2 Sorajja PSorajja P, Vemulapalli S, Feldman T et al. Outcomes with transcatheter mitral valve repair in the United States: An STS/ACC TVT registry report. J Am Coll Cardiol 2017 Nov 7; 70:2315. (http://dx.doi.org/10.1016/j.jacc.2017.09.015 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29096801
Bolling SF. First TMVR enters U.S. market as a therapy, and a gateway. J Am Coll Cardiol 2017 Nov 7; 70:2328 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29096802 - ↑ Jump up to: 5.0 5.1 Stone GW, Lindenfeld J, Abraham WT Transcatheter Mitral-Valve Repair in Patients with Heart Failure. N Engl J Med 2018 Sept 23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/30280640 Free Article https://www.nejm.org/doi/full/10.1056/NEJMoa1806640
- ↑ Sorajja P, Mack M, Vemulapalli S et al Initial Experience With Commercial Transcatheter Mitral Valve Repair in the United States. J Am Coll Cardiol. 2016 Mar 15;67(10):1129-1140. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26965532 Free Article
- ↑ Jump up to: 7.0 7.1 FDA News Release. March 14, 2019 FDA approves new indication for valve repair device to treat certain heart failure patients with mitral regurgitation. https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm633479.htm
- ↑ Jump up to: 8.0 8.1 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
- ↑ Jump up to: 9.0 9.1 Chhatriwalla AK et al. Operator experience and outcomes of transcatheter mitral valve repair in the United States. J Am Coll Cardiol 2019 Dec 17; 74:2955. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31568867
Resor CD. The TMVr operator volume and outcome relationship: More is more. J Am Coll Cardiol 2019 Dec 17; 74:2966 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31568870 - ↑ Jump up to: 10.0 10.1 Mack MJ, Lindenfeld J, Abraham WT et al. 3-year outcomes of transcatheter mitral valve repair in patients with heart failure. J Am Coll Cardiol 2021 Mar 2; 77:1029. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33632476 https://www.sciencedirect.com/science/article/abs/pii/S0735109720382656
Depta JP, Bhatt DL. Crossover in COAPT: Does this extend the reach of TMVr for treating functional MR? J Am Coll Cardiol 2021 Mar 2; 77:1041 PMID: https://www.ncbi.nlm.nih.gov/pubmed/33632477 https://www.sciencedirect.com/science/article/abs/pii/S0735109721000036 - ↑ Jump up to: 11.0 11.1 NEJM Knowledge+