Introduction:
Severe mitral valve regurgitation (MVR) is common valvular heart disease
with an unfavorable prognosis when left untreated (1, 2), and with a
prevalence of 2% in the general population (3).
When studying mitral valve pathology and its surgical implications it is
of necessity to assess the etiology of the disease. Acute MVR may occur
due to rupture of the papillary muscle in patients with acute STEMI (4).
It may also present due to disruption of different parts of the mitral
valve apparatus via infective endocarditis or spontaneous chordal
rupture in patients with degenerative mitral valve disease. When
assessing patients with chronic MVR, it is critical to distinguish
between chronic primary (degenerative) and chronic secondary
(functional) MVR, as these conditions are unequal (4) with the
subsequent implications for treatment.
Degenerative disease of the mitral valve represents 60-70% of patients
undergoing surgery in industrialized nations (5) and is most commonly
related to prolapse of the mitral valve with a spectrum of pre-existing
conditions, ranging from a single prolapsing valve segment to diffuse
myxomatous degeneration with bi-leaflet prolapse and annular dilatation
(5, 6).
Treatment algorithms have been redefined in recent years as a result of
the excellent outcomes of surgical repair with a recommendation of risk
stratification and earlier intervention when the probability of durable
repair is high and surgery can be undertaken by experienced teams with
high repair rates and low operative mortality and morbidity (2, 4, 7).
Numerous studies comparing mitral valve repair to replacement have
demonstrated a possible survival benefit for repair, with excellent
safety and durability. However, these findings are controversial in
light of reports showing a benefit for preventing recurrence of MVR and
rehospitalization when undergoing replacement, and in regard to present
reports, there are no randomized studies asserting MV repair to be
preferred to replacement (8). Nevertheless, some studies emphasized the
advantages of repair due to its lower operative mortality (9-11).
Our study aims to assess our institutional results of mitral valve
surgery classifying into repair and replacement groups, compare intra-
and postoperative results over a time span of 9 years, identify possible
risk factors influencing early and long-term results and analyze the
databank to obtain information to facilitate the decision-making process
in consideration of our results.