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.