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(Circulation. 2005;111:2154-2156.)
© 2005 American Heart Association, Inc.

Editorial

Percutaneous Mitral Valve Repair

Are They Changing the Guard?

Peter C. Block, MD

From the Department of Cardiology, Emory University Hospital, Atlanta, Ga.

Correspondence to Dr Peter C. Block, Emory University Hospital, 1364 Clifton Rd, F606, Atlanta, GA 30322. E-mail Peter_block@emoryhealthcare.org

Key Words: Editorials • mitral regurgitation • surgery • trials • echocardiography

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Treatment strategies for patients with mitral regurgitation (MR) are changing. Current guidelines suggest that patients with symptoms, atrial arrhythmias (especially atrial fibrillation), pulmonary hypertension, or left ventricular (LV) decompensation heralded by changes in LV ejection fraction should undergo mitral valve surgery.¹ In addition, for patients in whom valvular repair is likely, the guidelines also suggest that an asymptomatic patient with severe MR and normal LV function might undergo mitral valve repair to prevent the sequelae of chronic MR. Earlier and earlier treatment and mitral valve repair are now the surgical norm. In one sense, the guard is already changing.²

See p 2183

Repair of the mitral valve is associated with an at least equivalent late survival rate compared with replacement, and perhaps lower operative risk.^3,4 A reduced risk of endocarditis, fewer thromboembolic complications, and better preservation of LV function^5,6 make repair an attractive strategy; however, successful mitral valve surgery is dependent on individual valve pathology. In rheumatic mitral regurgitation, the distorted leaflet anatomy, associated subvalvular fibrosis, and calcification rarely allow valve repair. Patients with ischemic or congestive heart disease, LV remodeling, annular dilation, alteration of the subvalvular apparatus, and distorted leaflet coaptation present special challenges. Most surgeons attempt a complete repair, combining direct valvular restoration with an annuloplasty device. If the guard is to change successfully as we move toward percutaneous transcatheter repair, then valuable lessons learned during many years of surgical experience must not be forgotten. The challenges are magnified severalfold in percutaneous approaches.

The wind of change is . . . [Full Text of this Article]

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