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European Heart Journal Advance Access published online on November 15, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl381
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Mitral valve repair for severe mitral regurgitation: the way forward?

Simon Ray1,*, John Chambers3, Christa Gohlke-Baerwolf4 and Ben Bridgewater2

1 Department of Cardiology, South Manchester University Hospitals, Manchester M23 9LT, UK
2 Department of Cardiac Surgery, South Manchester University Hospitals, Manchester, UK
3 Department of Cardiology, Guys and St Thomas's Hospital, London, UK
4 Department of Cardiology, Herz-Zentrum, Bad Krozingen, Germany

Received 10 July 2006; revised 18 October 2006; accepted 26 October 2006.

* Corresponding author. Tel: +44 1612912402; fax: +44 1612912389. E-mail address: Simon.ray{at}smtr.nhs.uk

Severe primary mitral regurgitation (MR) has a poor outcome if left uncorrected. Successful mitral valve repair has the unique potential to restore normal life expectancy and is superior to valve replacement. Despite this, mitral repair is performed relatively infrequently and many patients with potentially reparable valves have a replacement instead, subjecting them to unnecessary risk. Surgery in asymptomatic patients is a particularly difficult issue with some units advocating surgery irrespective of symptoms, based purely on the severity of regurgitation. This strategy cannot be widely adopted with the current patchy provision of high-quality valve repair surgery. Misplaced enthusiasm for early operation runs the risk of a failed repair and the hazards of a mechanical prosthesis. To ensure optimal treatment for patients with MR, cardiologists must be aware of the indications for valve repair and ensure that patients with potentially reparable valves are referred to surgeons with proven expertise, even if this means a shift from established practice. Surgical units need to promote subspecialization and rigorously audit their outcomes. There are currently no agreed standards for best practice in mitral valve repair and this is an area where professional societies may wish to take a role.

Key Words: Mitral valve • Mitral regurgitation • Mitral valve repair • Surgical outcomes


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