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Surgical procedures for severe chronic mitral regurgitation

INTRODUCTION

Modern management of patients with chronic mitral regurgitation (MR) requires an understanding of multiple factors. These include:

  • The pathophysiology and natural history of the disease
  • The severity of the valvular lesion
  • The presence or absence of atrial fibrillation (AF)
  • The indications for mitral valve repair and mitral valve replacement

The only effective treatment is surgical valve repair or valve replacement [1].

Surgical procedures for severe chronic MR will be reviewed here. The indications for corrective surgery in chronic MR, an overview of the natural history and management of chronic MR, and issues related to mitral valve prolapse, ischemic MR, functional MR, and MR in elderly patients are discussed separately. (See "Indications for corrective surgery in severe chronic mitral regurgitation" and "Natural history of chronic mitral regurgitation in mitral valve prolapse and flail mitral leaflet" and "Overview of the management of chronic mitral regurgitation" and "Ischemic mitral regurgitation" and "Functional mitral regurgitation" and "Valvular heart disease in elderly adults".)

PREOPERATIVE CONSIDERATIONS

Randomized trials have not been performed comparing medical therapy to surgery in patients with severe chronic MR who meet the indications for corrective surgery. However, symptoms are clearly improved and a survival benefit has been suggested on multivariate analysis in observational studies in which some patients had undergone surgery [2,3]. (See "Indications for corrective surgery in severe chronic mitral regurgitation".)
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