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10.5606/tgkdc.dergisi.2022.23340
Surgical mitral valve repair technique considerations based on the available evidence
Tolga Can1, Hristo Kirov1, Tulio Caldonazo1, Murat Mukharyamov1, Gloria Färber1, Torsten Doenst1
1Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University of Jena, Jena, Germany
DOI : 10.5606/tgkdc.dergisi.2022.23340
Mitral valve regurgitation is the second most common
valve disease in the western world. Surgery is currently the
best tool for generating a long-lasting elimination of mitral
valve regurgitation. However, the mitral valve apparatus is
a complex anatomical and functional structure, and repair
results and durability show substantial heterogeneity. This
is not only due to differences in the underlying mitral valve
regurgitation pathophysiology but also due to differences in
repair techniques. Repair philosophies differ substantially
from one surgeon to the other, and consensus for the
technically best repair strategy has not been reached yet.
We had previously addressed this topic by suggesting
that ring sizing is "voodoo". We now review the available
evidence regarding the various repair techniques described
for structural and functional mitral valve regurgitation.
Herein, we illustrate that for structural mitral valve
regurgitation, resuspension of prolapsing valve segments
or torn chordae with polytetrafluoroethylene sutures and
annuloplasty can generate the most durable results paired
with the best achievable hemodynamics. For functional
mitral valve regurgitation, the evidence suggests that
annuloplasty alone is insufficient in most cases to generate
durable results, and additional subvalvular strategies are
associated with improved durability and possibly improved
clinical outcomes. This review addresses current strategies
but also implausibilities in mitral valve repair and informs
the mitral valve surgeon about the current evidence. We
believe that this information may help improve outcomes
in mitral valve repair as the heterogeneity of mitral
valve regurgitation pathophysiology does not allow a
one-size-fits-all concept.
Keywords : Degenerative mitral regurgitation, functional mitral regurgitation, mitral valve repair
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