Skip to main content
Log in

Mitral valve repair in the treatment of mitral regurgitation

  • Published:
Current Treatment Options in Cardiovascular Medicine Aims and scope Submit manuscript

Opinion statement

Because there is no proven effective medical therapy for mitral regurgitation (MR), mitral valve repair (MVRpr) is the treatment of choice for patients with severe primary nonrheumatic MR. A successfully performed and properly timed MVRpr may lead to a normal lifestyle and life span. The alternative to repair is mitral valve replacement. Although there have been no randomized trials of repair versus replacement, almost all reported series demonstrate superior outcomes with repair, and current guidelines clearly prefer MVRpr over mitral valve replacement for patients with nonrheumatic MR.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Bonow RO, Carabello BA, Chatterjee K, et al.: ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) developed in collaboration with the Society of Cardiovascular Anesthesiologists endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons. J Am Coll Cardiol 2006, 48:1–148.

    Article  Google Scholar 

  2. Enriquez-Sarano M, Schaff HV, Orszulak TA, et al.: Valve repair improves the outcome of surgery for mitral regurgitation analysis. Circulation 1995, 91:1022–1028.

    PubMed  CAS  Google Scholar 

  3. Horstkotte D, Schulte HD, Bircks W, Strauer BE: The effect of chordal preservation on late outcome after mitral valve replacement: a randomized study. J Heart Valve Dis 1993, 2:150–158.

    Google Scholar 

  4. Jokinen JJ, Hippelainen MJ, Pitkanen OA, Hartikainen JE: Mitral valve replacement versus repair: propensity-adjusted survival and quality-of-life analysis. Ann Thorac Surg 2007, 84:451–458.

    Article  PubMed  Google Scholar 

  5. David TE: Outcomes of mitral valve repair for mitral regurgitation due to degenerative disease. Semin Thorac Cardiovasc Surg 2007, 19:116–120.

    Article  PubMed  Google Scholar 

  6. Rushmer RF, Finlayson BL, Nash AA: Movements of the mitral valve. Circ Res 1956, 4:337–342.

    PubMed  CAS  Google Scholar 

  7. Lillehei CW, Levy MJ, Bonnabeau RC Jr: Mitral valve replacement with preservation of papillary muscles and chordae tendineae. J Thorac Cardiovasc Surg 1964, 47:532–543.

    PubMed  CAS  Google Scholar 

  8. Carpentier A, Deloche A, Dauptain J, et al.: A new reconstructive operation for correction of mitral and tricuspid insufficiency. J Thorac Cardiovasc Surg 1971, 61:1–13.

    PubMed  CAS  Google Scholar 

  9. Cohn LH, Reis RL, Morrow AG: Left ventricular function after mitral valve replacement. Comparative studies following resection of preservation of chordae tendineae. J Thorac Cardiovasc Surg 1968, 56:11–15.

    PubMed  CAS  Google Scholar 

  10. Carpentier A, Relland J, Deloche A, et al.: Conservative management of the prolapsed mitral valve. Ann Thorac Surg 1978, 26:294–302.

    PubMed  CAS  Google Scholar 

  11. Duran CM, Pomar JL, Caro M: Changing concepts in the surgical treatment of acquired valvular disease. Annuloplasties. J Cardiovasc Surg (Torino) 1973, Spec No:387–389.

  12. Lindblom D, Lindblom U, Qvist J, Lundstrom H: Long-term relative survival rates after heart valve replacement. J Am Coll Cardiol 1990, 15:566–573.

    Article  PubMed  CAS  Google Scholar 

  13. David TE, Burns RJ, Bacchus CM, Druck MN: Mitral valve replacement for mitral regurgitation with and without preservation of chordae tendineae. J Thorac Cardiovasc Surg 1984, 88:718–725.

    PubMed  CAS  Google Scholar 

  14. Rozich JD, Carabello BA, Usher BW, et al.: Mitral valve replacement with and without chordal preservation in patients with chronic mitral regurgitation: mechanisms for differences in post-operative ejection performance. Circulation 1992, 86:1718–1726.

    PubMed  CAS  Google Scholar 

  15. Sarris GE, Cahill PD, Hansen DE, et al.: Restoration of left ventricular systolic performance after reattachment of the mitral chordae tendineae: The importance of valvular-ventricular interaction. J Thorac Cardiovasc Surg 1988, 95:969–979.

    PubMed  CAS  Google Scholar 

  16. Braunberger E, Deloche A, Berrebi A, et al.: Very long-term results (more than 20 years) of valve repair with carpentier’s techniques in nonrheumatic mitral valve insufficiency. Circulation 2001, 104(Suppl 1):I8–I11.

    PubMed  CAS  Google Scholar 

  17. Tribouilloy CM, Enriquez-Sarano M, Schaff HV, et al.: Impact of preoperative symptoms on survival after surgical correction of organic mitral regurgitation: rationale for optimizing surgical indications. Circulation 1999, 99:400–405.

    PubMed  CAS  Google Scholar 

  18. Enriquez-Sarano M, Tajik AJ, Schaff HV, et al.: Echocardiographic prediction of survival after surgical correction of organic mitral regurgitation. Circulation 1994, 90:830–837.

    PubMed  CAS  Google Scholar 

  19. Matsumura T, Ohtaki E, Tanaka K, et al.: Echocardiographic prediction of left ventricular dysfunction after mitral valve repair for mitral regurgitation as an indicator to decide the optimal timing of repair. J Am Coll Cardiol 2003, 42:458–463.

    Article  PubMed  Google Scholar 

  20. Rosenhek R, Rader F, Klaar U, et al.: Outcomes of watchful waiting in asymptomatic severe mitral regurgitation. Circulation 2006, 113:2238–2244.

    Article  PubMed  Google Scholar 

  21. Enriquez-Sarano M, Avierinos JF, Messika-Zeitoun D, et al.: Quantitative determinants of the outcome of asymptomatic mitral regurgitation. N Eng J Med 2005, 352:2245–2246.

    Article  Google Scholar 

  22. Kang DH, Kim JH, Rim JH, et al.: Comparison of early surgery versus conventional treatment in asymptomatic severe mitral regurgitation. Circulation 2009, 119:797–804.

    Article  PubMed  Google Scholar 

  23. Gillinov AM, Blackstone EH, Alaulaqi A, et al.: Outcomes after repair of the anterior mitral leaflet for degenerative disease. Ann Thorac Surg 2008, 86:708–717; discussion 708–717.

    Article  PubMed  Google Scholar 

  24. Gillinov AM, Tantiwongkosri K, Blackstone EH, et al.: Is prosthetic anuloplasty necessary for durable mitral valve repair? Ann Thorac Surg 2009, 88:76–82.

    Article  PubMed  Google Scholar 

  25. Adams DH, Anyanwu AC: Seeking a higher standard for degenerative mitral valve repair: begin with etiology. J Thorac Cardiovasc Surg 2008, 136:551–556.

    Article  PubMed  Google Scholar 

  26. Alfieri O, De Bonis M, Lapenna E, et al.: “Edge-to-edge” repair for anterior mitral leaflet prolapse. Semin Thorac Cardiovasc Surg 2004, 16:182–187.

    Article  PubMed  Google Scholar 

  27. Zakkar M, Amirak E, Chan KM, Punjabi PP: Rheumatic mitral valve disease: current surgical status. Prog Cardiovasc Dis 2009, 51:478–481.

    Article  PubMed  Google Scholar 

  28. Nakano K, Swindle MM, Spinale F, et al.: Depressed contractile function due to canine mitral regurgitation improves after correction of the volume overload. J Clin Invest 1991, 87:2077–2086.

    Article  PubMed  CAS  Google Scholar 

  29. Starling MR: Effects of valve surgery on left ventricular function in patients with long-term mitral regurgitation. Circulation 1995, 92:811–818.

    PubMed  CAS  Google Scholar 

  30. Trichon BH, Felker GM, Shaw LK, et al.: Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol 2003, 91:538–543.

    Article  PubMed  Google Scholar 

  31. Bach DS, Bolling SF: Improvement of following correction of secondary mitral regurgitation in end-stage cardiomyopathy with mitral annuloplasty. Am J Cardiol 1996, 78:966–969.

    Article  PubMed  CAS  Google Scholar 

  32. Bax JJ, Braun J, Somer ST, et al.: Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodeling. Circulation 2004, 110(Suppl 1):II103–II108.

    PubMed  Google Scholar 

  33. Acker MA, Bolling S, Shemin R, et al.; Acorn Trial Principle Investigators and Study Coordinators: Mitral valve surgery in heart failure: insights from the Acorn Clinical Trial. J Thorac Cardiovasc Surg 2006, 132:568–577.

    Article  PubMed  Google Scholar 

  34. Braun J, Bax JJ, Versteegh MI, et al.: Preoperative left ventricular dimensions predict reverse remodeling following restrictive mitral annuloplasty in ischemic mitral regurgitation. Eur J Cardiothorac Surg 2005, 27:847–853.

    Article  PubMed  Google Scholar 

  35. Wu AH, Aaronson KD, Billing SF, et al.: Impact of mitral valve annuloplasty on mortality risk in patients with mitral regurgitation and left ventricular systolic dysfunction. J Am Coll Cardiol 2005, 45:381–387.

    Article  PubMed  Google Scholar 

  36. Mihaljevic T, Lam BK, Rajeswaran J, et al.: Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation. J Am Coll Cardiol 2007, 49:2191–2203.

    Article  PubMed  Google Scholar 

  37. Diodato MD, Moon MR, Pasque MK, et al.: Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: a propensity analysis. Ann Thorac Surg 2004, 78:794–799; discussion 794–799.

    Article  PubMed  Google Scholar 

  38. Kang DH, Kim MJ, Kang SJ, et al.: Mitral valve repair versus revascularization alone in the treatment of ischemic mitral regurgitation. Circulation 2006, 114(I Suppl):I499–I503.

    PubMed  Google Scholar 

  39. Condado JA, Acquatella H, Rodriguez L, et al.: Percutaneous edge-to-edge mitral valve repair: 2-year follow-up in the first human case. Catheter Cardiovasc Interv 2006, 677:323–325.

    Article  Google Scholar 

  40. Webb JG, Harnek J, Munt BI, et al.: Percutaneous transvenous mitral annuloplasty: initial human experience with device implantation in the coronary sinus. Circulation 2006, 113:851–855.

    Article  PubMed  Google Scholar 

  41. Piazza N, Asgar A, Ibrahim R, Bonan R: Transcatheter mitral and pulmonary valve therapy. J Am Coll of Cardiol 2009, 53:1837–1851.

    Article  Google Scholar 

  42. Yoran C, Yellin EL, Becker RM, et al.: Mechanisms of reduction of mitral regurgitation with vasodilator therapy. Am J Cardiol 1979, 43:773–777.

    Article  PubMed  CAS  Google Scholar 

  43. Host U, Kelbaek H, Hildebrandt P, et al.: Effect of ramipril on mitral regurgitation secondary to mitral valve prolapsed. Am J Cardiol 1997, 80:655–658.

    Article  PubMed  CAS  Google Scholar 

  44. Marcotte F, Honos GN, Walling AD, et al.: Effect of angiotensin-converting enzyme inhibitor therapy in mitral regurgitation with normal left ventricular function. Can J Cardiol 1997, 13:479–485.

    PubMed  CAS  Google Scholar 

  45. Tischler MD, Rowan M, LeWinter MM: Effect of enalapril therapy on left ventricular mass and volume in asymptomatic chronic, severe mitral regurgitation secondary to mitral valve prolapsed. Am J Cardiol 1998, 82:242–245.

    Article  PubMed  CAS  Google Scholar 

  46. Wisenbaugh T, Sinovich V, Dullabh A, Sareli P: Six month pilot study of captopril for mildly symptomatic, severe isolated mitral and isolated aortic regurgitation. J Heart Valve Dis 1994, 3:197–204.

    PubMed  CAS  Google Scholar 

  47. Stewart RA, Raffel OC, Kerr AJ, et al.: Pilot study to assess the influence of beta-blockade on mitral regurgitant volume and left ventricular work in degenerative mitral valve disease. Circulation 2008, 118:1041–1046.

    Article  PubMed  CAS  Google Scholar 

  48. Varadarajan P, Joshi N, Appel D, et al.: Effect of betablocker therapy on survival in patients with severe mitral regurgitation and normal left ventricular ejection fraction. Am J Cardiol 2008, 102:611–615.

    Article  PubMed  CAS  Google Scholar 

  49. St. John Sutton MG, Plappert T, Abraham WT, et al.; Multicenter In Sync Randomized Clinical Evaluation (MIRACLE) Study Group: Effect of cardiac resynchronization therapy on left ventricular size and function in chronic heart failure. Circulation 2003, 107:1985–1990.

    Article  PubMed  Google Scholar 

  50. Carabello BA: Mitral valve disease. Curr Probl Cardiol 1993, 18:421–480.

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Blase A. Carabello.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Carabello, B.A. Mitral valve repair in the treatment of mitral regurgitation. Curr Treat Options Cardio Med 11, 419–425 (2009). https://doi.org/10.1007/s11936-009-0044-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11936-009-0044-2

Keywords

Navigation