Mitral Valve Devices

Abstract

Mitral valve regurgitation (MR) is an important clinical issue as MR represents >30% of native valve diseases (Enriquez-Sarano et al. 2009). Patients with symptomatic MR not only experience a low quality of life, but also have a poor prognosis with a 5% annual mortality rate in the absence of surgery (Alvarez et al. 1996; Mirabel et al. 2007). Optimal medical management can improve symptoms of heart failure but does not affect survival (Carabello 2008). Therefore, surgery is recommended by the current guidelines for patients with symptomatic severe MR or asymptomatic severe MR with evidence of left ventricular (LV) dysfunction or dilatation (Bonow et al. 2008; Vahanian et al. 2007). Studies have shown that despite a severe MR and symptoms up to 50% of the patients are not considered to be eligible for surgery. Reasons for denying surgery include impaired left ventricular ejection fraction, a high operative risk, multiple comorbidities or advanced age (Mirabel et al. 2007). When surgery is performed, mitral valve repair, rather than replacement, has become the preferred surgical treatment for severe MR since mitral valve repair has improves patients outcome, preserves the left ventricular function and eliminates the need for chronic anticoagulation therapy. However the benefit of repair over replacement in patients with a functional MR is less certain (Enriquez-Sarano et al. 1995; Gillinov et al. 2001).