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.