Introduction and Background
Mitral valve repair (MVr) is recommended for severe mitral valve (MV)
regurgitation due to degenerative leaflet prolapse. However, despite
extensive evidence of the superiority of valve repair over valve
replacement, repair rates remain highly variable among different
centers. Factors contributing to replacement rather than repair include
surgeon experience, hospital case volume, and the complexity of valvular
pathology. Referring patients to centers with surgical experience and
expertise in mitral valve repair may help increase overall repair rates.
A MV disease scoring system was previously developed by Anyanwu et al.
to measure valve complexity and difficulty of surgical repair. The
scoring system divides degenerative mitral valve prolapse into 3
strata—simple, intermediate, and complex—based on the expected
complexity of repair. The scoring system seemed to be directly
correlated to the surgical complexity . Importantly, echo-guided repair,
including 3D echocardiography, has separately been shown be associated
with higher repair rates as well as excellent long-term results.
Transesophageal echocardiography has not yet been investigated as a
means for stratifying mitral degenerative disease or predicting the
complexity of mitral surgical repair. All components of the previously
derived surgical score can be evaluated using preoperative
echocardiography. We hypothesize that pre-bypass TEE prior to skin
incision by experienced cardiac anesthesiologists can corroborate the
previously published surgical mitral valve complexity score and
therefore potentially improve early prediction and stratification of
mitral valve disease surgical complexity.