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Valvular Heart Disease pp 131–176Cite as

Innovative Approaches to Mitral Valve Repair and Replacement

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Part of the book series: Cardiovascular Medicine ((CVM))

Abstract

Mitral valve disease is the most common valvular disorder worldwide. Mitral stenosis rates have been declining, but mitral regurgitation remains the most common valvular disease in the United States. Medical therapy has a limited role in the treatment of mitral valve disorders, and surgery with either valve repair or replacement remains the mainstay of treatment. A thorough understanding of the complex mitral valve apparatus, pathophysiology of the valve, echocardiographic findings, and grading classification of regurgitation and stenosis are all essential to guiding optimal patient management and, ultimately, surgical care.

Surgery for mitral valve disease has progressed significantly as innovations in surgical technique, instrumentation, and cardiopulmonary bypass have developed. Rather than standard sternotomy, various minimally invasive approaches are now used to gain access to the mitral valve. The most commonly employed minimally invasive approaches include the right mini-thoracotomy with direct vision, video thoracoscopic visualization, and robotically assisted surgical techniques. A thorough preoperative evaluation and an understanding of the indications and contraindications for using a minimally invasive approach are vital to proper patient selection. In addition, a detailed review of the patient’s echocardiograms, combined with knowledge of the mitral valve apparatus, helps determine which surgical technique is optimal for valve repair. Annuloplasty, leaflet resection or folding plasty, creating artificial chordae, commissurotomy, leaflet extension or augmentation, and an edge-to-edge Alfieri suture are among the techniques used in valve repair. Despite the availability of many techniques, valve repair is not always possible or feasible, in which case valve replacement is performed.

Various transcatheter and endovascular devices are available for both mitral valve repair and replacement. The transcatheter devices make possible a spectrum of repair techniques designed to imitate surgical repairs. Devices for annuloplasty, edge-to-edge repair, and the creation of artificial chordae have been developed, and many, such as the MitraClip, are already in widespread use. However, devices for transcatheter mitral valve replacement remain in the development stage. As these devices are further engineered and tested, they may become available for use in a larger patient population. Currently, they remain restricted to patients who are not surgical candidates.

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Authors and Affiliations

  1. Division of Cardiac Surgery, CHI St. Luke’s Health—Baylor St. Luke’s Medical Center, Houston, TX, USA

    Joseph Lamelas

  2. Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA

    Joseph Lamelas

  3. Cardiothoracic Surgery, Texas Heart Institute—Baylor College of Medicine, Houston, TX, USA

    Corinne M. Aberle & Swaminadhan Gnanashanmugam

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  1. Joseph Lamelas
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  2. Corinne M. Aberle
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  3. Swaminadhan Gnanashanmugam
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  1. Brody School of Medicine, East Carolina University, Greenville, NC, USA

    Blase A. Carabello

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Lamelas, J., Aberle, C.M., Gnanashanmugam, S. (2020). Innovative Approaches to Mitral Valve Repair and Replacement. In: Carabello, B. (eds) Valvular Heart Disease. Cardiovascular Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-2840-3_8

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