MITRAL VALVE DISEASE
Mitral Regurgitation (MR) accounts for the vast majority of all mitral valve diseases.1 It has a prevalence of approximately 2% in the general population and is more common in the elderly population.3 Approximately 10% of people over the age of 70 have clinically meaningful MR.5
If left untreated, MR can lead to Heart Failure (HF), or deterioration of pre-existing HF, resulting in an increased number of hospital admissions and a substantial cost burden to health systems.6,8
PRIMARY MITRAL REGURGITATION (PMR)
Surgical repair of the mitral valve is the gold standard treatment for PMR in patients with evidence of left ventricular (LV) dysfunction or dilation.6,17,22 Surgery can dramatically improve outcomes, with survival at 5 and 10 years reported at 97% and 100% of the expected survival for the general population, respectively (p=0.68).23 However, up to 50% of patients may not meet the eligibility criteria due to risks associated with age or the presence of comorbidities.24
SECONDARY MITRAL REGURGITATION (SMR)
Surgical treatment of SMR has not been widely adopted despite a possibly effective reduction of MR due to the risks posed by the invasive intervention involving cardiopulmonary bypass, cardioplegia and iatrogenic ischemia may add an insult to an already diseased myocardium. Mitral valve surgery can acutely correct SMR, but has never clearly been demonstrated to alter the natural history of the primary disease or improve survival.25
Approximately 50% of PMR patients are not candidates for surgery due to underlying factors
Factors prohibiting surgery include:
- Impaired LVEF
- High operative risk
- Multiple comorbidities
- Advanced age
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References
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Working Groups on Cardiovascular Surgery and Valvular Heart Disease. Eur Heart J. 2016;37(2):133–9. doi.org/10.1093/eurheartj/ehv322. - Cahill TJ, Prothero A, Wilson J, et al. Community prevalence, mechanisms and outcome of mitral or tricuspid regurgitation. Heart. 2021;107(12):1003–9.
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