Materiały źródłowe

• #1 Treating mitral valve regurgitation – Mayo Clinic Health System

  https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/treating-mitral-valve-regurgitation

  Mitral valve regurgitation is the most common type of valvular heart disease in the U.S. The prevalence of the condition increases with age. About 10% of adults over 75 have mitral valve regurgitation. […] Severe, symptomatic mitral valve regurgitation can weaken the heart and lower life expectancy if not treated. […] The goal of treatment is to improve heart function and reduce symptoms. This may include regular monitoring, medication, valve repair or valve replacement. […] For severe cases, the healthcare team may recommend repairing a leaky valve with open heart mitral valve repair or replacement surgery. In suitable patients, the mitral valve also can be repaired without open heart surgery using a catheter-based endovascular procedure. […] Transcatheter edge-to-edge repair, or TEER, of the mitral valve is an alternative to traditional open-heart surgery to treat a leaky valve. The minimally invasive procedure is performed in a cardiac catheterization lab. […] A TEER procedure may be a good option if you have severe mitral valve regurgitation, aren’t a good candidate for open-heart surgery, or have heart failure with mitral valve regurgitation due to heart enlargement.

• #2 Mitral Valve Regurgitation: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/mitral-valve-regurgitation/treatment

  Mitral valve regurgitation treatments depend on the severity of the condition and whether it is causing symptoms. The first step is determining whether you have mild or severe regurgitation and whether it involves degenerative mitral valve disease. For patients with degenerative valve disease, our centers offer the latest in minimally invasive and surgical repair techniques. […] For more severe cases of mitral valve regurgitation, treatment is often necessary to improve symptoms and prevent serious complications like congestive heart failure. […] Treatments for mitral valve regurgitation can include medicines called beta-blockers and ACE inhibitors (which lessen the workload on the heart), medicines that slow your heart rate, and medicines to manage symptoms like swelling. […] As your condition progresses, surgery may be the best option to reduce symptoms and lower your risk of serious complications like congestive heart failure and atrial fibrillation, which can cause strokes. Modern surgical treatment for mitral valve regurgitation uses minimally invasive techniques when possible, to reduce your recovery time and complications.

• #3 Mitral Valve Regurgitation: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/mitral-valve-regurgitation/treatment

  Mitral valve regurgitation treatments depend on the severity of the condition and whether it is causing symptoms. The first step is determining whether you have mild or severe regurgitation and whether it involves degenerative mitral valve disease. For patients with degenerative valve disease, our centers offer the latest in minimally invasive and surgical repair techniques. […] For more severe cases of mitral valve regurgitation, treatment is often necessary to improve symptoms and prevent serious complications like congestive heart failure. […] Treatments for mitral valve regurgitation can include medicines called beta-blockers and ACE inhibitors (which lessen the workload on the heart), medicines that slow your heart rate, and medicines to manage symptoms like swelling. […] As your condition progresses, surgery may be the best option to reduce symptoms and lower your risk of serious complications like congestive heart failure and atrial fibrillation, which can cause strokes. Modern surgical treatment for mitral valve regurgitation uses minimally invasive techniques when possible, to reduce your recovery time and complications.

• #4 Mitral valve regurgitation Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/mitral-valve-regurgitation

  Treatment will depend on what symptoms you have, what condition caused the mitral valve regurgitation, how well the heart is working, and if the heart has become enlarged. […] People with high blood pressure or a weakened heart muscle may be given medicines to reduce the strain on the heart and ease symptoms. […] The following medicines may be prescribed when mitral regurgitation symptoms get worse: Beta-blockers, ACE inhibitors, or calcium channel blockers; Blood thinners (anticoagulants) to help prevent blood clots in people with atrial fibrillation; Medicines that help control uneven or abnormal heartbeats; Water pills (diuretics) to remove excess fluid in the lungs. […] A low-sodium diet may be helpful. You may need to limit your activity if symptoms develop. […] Once the diagnosis is made, you should visit your provider regularly to track your symptoms and heart function.

• #5 Mitral Valve Disease | NYU Langone Health

  https://nyulangone.org/conditions/mitral-valve-disease

  Doctors at our Heart Valve Center are pioneers in innovative procedures for the treatment of mitral valve disease. […] At our Mitral Valve Repair Program, we use open, robotic, and minimally invasive surgical techniques to treat mitral valve disease. […] At the Transcatheter Heart Valve Program, our doctors use nonsurgical transcatheter-based techniques to repair and replace the mitral valve. […] Mitral valve disease treatment includes robotic, minimally invasive, and transcatheter techniques. […] When required, our surgeons perform sternotomy, also known as open heart surgery, which can be done by dividing the breastbone or through small incisions in the ribcage. […] Transcatheter procedures have shown to improve quality of life and provide longevity for those who have mitral valve disease. […] Damaged mitral valves can be repaired using robotic procedures. […] Damaged mitral valves can be repaired using minimally invasive techniques.

• #6 Mitral Regurgitation Treatment Options| UVA Health

  https://uvahealth.com/services/heart-valve-disease/mitral-regurgitation

  Mitral regurgitation is a common condition that affects the mitral valve. This valve is responsible for regulating the flow of blood from the lungs to the heart. […] MR rarely requires immediate treatment. If you have mild or moderate symptoms, you have time to think about your options. And at UVA Health, you have several options for how you address this. […] Medications cant fix mitral regurgitation. But they can help to alleviate some of the symptoms. […] At UVA Health, we offer several different procedures to address this condition. […] In the 1990s, UVA was at the forefront of developing the techniques used to repair heart valves. With a repair, were able to fix your own valve instead of replacing it. […] If possible, wed like to repair your mitral valve. But if thats not possible, well talk to you about mitral valve replacement.

• #7 Mitral Regurgitation Treatment Options| UVA Health

  https://uvahealth.com/services/heart-valve-disease/mitral-regurgitation

  Mitral regurgitation is a common condition that affects the mitral valve. This valve is responsible for regulating the flow of blood from the lungs to the heart. […] MR rarely requires immediate treatment. If you have mild or moderate symptoms, you have time to think about your options. And at UVA Health, you have several options for how you address this. […] Medications cant fix mitral regurgitation. But they can help to alleviate some of the symptoms. […] At UVA Health, we offer several different procedures to address this condition. […] In the 1990s, UVA was at the forefront of developing the techniques used to repair heart valves. With a repair, were able to fix your own valve instead of replacing it. […] If possible, wed like to repair your mitral valve. But if thats not possible, well talk to you about mitral valve replacement.

• #8 Mitral valve regurgitation Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/mitral-valve-regurgitation

  Treatment will depend on what symptoms you have, what condition caused the mitral valve regurgitation, how well the heart is working, and if the heart has become enlarged. […] People with high blood pressure or a weakened heart muscle may be given medicines to reduce the strain on the heart and ease symptoms. […] The following medicines may be prescribed when mitral regurgitation symptoms get worse: Beta-blockers, ACE inhibitors, or calcium channel blockers; Blood thinners (anticoagulants) to help prevent blood clots in people with atrial fibrillation; Medicines that help control uneven or abnormal heartbeats; Water pills (diuretics) to remove excess fluid in the lungs. […] A low-sodium diet may be helpful. You may need to limit your activity if symptoms develop. […] Once the diagnosis is made, you should visit your provider regularly to track your symptoms and heart function.

• #9 Mitral valve regurgitation Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/mitral-valve-regurgitation

  Treatment will depend on what symptoms you have, what condition caused the mitral valve regurgitation, how well the heart is working, and if the heart has become enlarged. […] People with high blood pressure or a weakened heart muscle may be given medicines to reduce the strain on the heart and ease symptoms. […] The following medicines may be prescribed when mitral regurgitation symptoms get worse: Beta-blockers, ACE inhibitors, or calcium channel blockers; Blood thinners (anticoagulants) to help prevent blood clots in people with atrial fibrillation; Medicines that help control uneven or abnormal heartbeats; Water pills (diuretics) to remove excess fluid in the lungs. […] A low-sodium diet may be helpful. You may need to limit your activity if symptoms develop. […] Once the diagnosis is made, you should visit your provider regularly to track your symptoms and heart function.

• #10 Mitral Valve Regurgitation: Diagnosis & Treatment | Mass General Brigham

  https://www.massgeneralbrigham.org/en/patient-care/services-and-specialties/heart/conditions/mitral-valve-regurgitation/treatment

  Mitral valve regurgitation treatments depend on the severity of the condition and whether it is causing symptoms. The first step is determining whether you have mild or severe regurgitation and whether it involves degenerative mitral valve disease. For patients with degenerative valve disease, our centers offer the latest in minimally invasive and surgical repair techniques. […] For more severe cases of mitral valve regurgitation, treatment is often necessary to improve symptoms and prevent serious complications like congestive heart failure. […] Treatments for mitral valve regurgitation can include medicines called beta-blockers and ACE inhibitors (which lessen the workload on the heart), medicines that slow your heart rate, and medicines to manage symptoms like swelling. […] As your condition progresses, surgery may be the best option to reduce symptoms and lower your risk of serious complications like congestive heart failure and atrial fibrillation, which can cause strokes. Modern surgical treatment for mitral valve regurgitation uses minimally invasive techniques when possible, to reduce your recovery time and complications.

• #11 Mitral valve regurgitation Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/mitral-valve-regurgitation

  Treatment will depend on what symptoms you have, what condition caused the mitral valve regurgitation, how well the heart is working, and if the heart has become enlarged. […] People with high blood pressure or a weakened heart muscle may be given medicines to reduce the strain on the heart and ease symptoms. […] The following medicines may be prescribed when mitral regurgitation symptoms get worse: Beta-blockers, ACE inhibitors, or calcium channel blockers; Blood thinners (anticoagulants) to help prevent blood clots in people with atrial fibrillation; Medicines that help control uneven or abnormal heartbeats; Water pills (diuretics) to remove excess fluid in the lungs. […] A low-sodium diet may be helpful. You may need to limit your activity if symptoms develop. […] Once the diagnosis is made, you should visit your provider regularly to track your symptoms and heart function.

• #12 Mitral valve regurgitation Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/mitral-valve-regurgitation

  Treatment will depend on what symptoms you have, what condition caused the mitral valve regurgitation, how well the heart is working, and if the heart has become enlarged. […] People with high blood pressure or a weakened heart muscle may be given medicines to reduce the strain on the heart and ease symptoms. […] The following medicines may be prescribed when mitral regurgitation symptoms get worse: Beta-blockers, ACE inhibitors, or calcium channel blockers; Blood thinners (anticoagulants) to help prevent blood clots in people with atrial fibrillation; Medicines that help control uneven or abnormal heartbeats; Water pills (diuretics) to remove excess fluid in the lungs. […] A low-sodium diet may be helpful. You may need to limit your activity if symptoms develop. […] Once the diagnosis is made, you should visit your provider regularly to track your symptoms and heart function.

• #13 Mitral valve regurgitation Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/mitral-valve-regurgitation

  Treatment will depend on what symptoms you have, what condition caused the mitral valve regurgitation, how well the heart is working, and if the heart has become enlarged. […] People with high blood pressure or a weakened heart muscle may be given medicines to reduce the strain on the heart and ease symptoms. […] The following medicines may be prescribed when mitral regurgitation symptoms get worse: Beta-blockers, ACE inhibitors, or calcium channel blockers; Blood thinners (anticoagulants) to help prevent blood clots in people with atrial fibrillation; Medicines that help control uneven or abnormal heartbeats; Water pills (diuretics) to remove excess fluid in the lungs. […] A low-sodium diet may be helpful. You may need to limit your activity if symptoms develop. […] Once the diagnosis is made, you should visit your provider regularly to track your symptoms and heart function.

• #14 The Role of Medical Therapy in Moderate to Severe Degenerative Mitral Regurgitation – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27667378/

  Mitral regurgitation (MR) is a common valvular disorder that has important health and economic consequences. Standardized guidelines exist regarding when and in whom to perform mitral valve surgery, but little information is available regarding medical treatment of MR. Many patients with moderate or severe MR do not meet criteria for surgery or are deemed to be at high risk for surgical therapy. […] We reviewed the available published data on medical therapy in the treatment of patients with primary MR. b-blockers and renin-angiotensin-aldosterone system inhibitors had the strongest supporting evidence for providing beneficial effects. b-blockers appear to lessen MR, prevent deterioration of left ventricular function, and improve survival in asymptomatic patients with moderate to severe primary MR. Angiotensin-converting enzyme inhibitor and angiotensin receptor blocker therapy reduces MR, especially in asymptomatic patients. However, in the setting of hypertrophic cardiomyopathy or mitral valve prolapse, vasodilators can increase the severity of MR. To define the precise role of medical therapy, a larger randomized controlled trial is needed to confirm benefit and assess in which subsets of patients medical therapy is most useful. Medical therapy in some patients improves symptoms, lessens MR, and may delay the need for surgical intervention.

• #15 The Role of Medical Therapy in Moderate to Severe Degenerative Mitral Regurgitation – PubMed

  https://pubmed.ncbi.nlm.nih.gov/27667378/

  Mitral regurgitation (MR) is a common valvular disorder that has important health and economic consequences. Standardized guidelines exist regarding when and in whom to perform mitral valve surgery, but little information is available regarding medical treatment of MR. Many patients with moderate or severe MR do not meet criteria for surgery or are deemed to be at high risk for surgical therapy. […] We reviewed the available published data on medical therapy in the treatment of patients with primary MR. b-blockers and renin-angiotensin-aldosterone system inhibitors had the strongest supporting evidence for providing beneficial effects. b-blockers appear to lessen MR, prevent deterioration of left ventricular function, and improve survival in asymptomatic patients with moderate to severe primary MR. Angiotensin-converting enzyme inhibitor and angiotensin receptor blocker therapy reduces MR, especially in asymptomatic patients. However, in the setting of hypertrophic cardiomyopathy or mitral valve prolapse, vasodilators can increase the severity of MR. To define the precise role of medical therapy, a larger randomized controlled trial is needed to confirm benefit and assess in which subsets of patients medical therapy is most useful. Medical therapy in some patients improves symptoms, lessens MR, and may delay the need for surgical intervention.

• #16 Mitral valve regurgitation Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/mitral-valve-regurgitation

  Treatment will depend on what symptoms you have, what condition caused the mitral valve regurgitation, how well the heart is working, and if the heart has become enlarged. […] People with high blood pressure or a weakened heart muscle may be given medicines to reduce the strain on the heart and ease symptoms. […] The following medicines may be prescribed when mitral regurgitation symptoms get worse: Beta-blockers, ACE inhibitors, or calcium channel blockers; Blood thinners (anticoagulants) to help prevent blood clots in people with atrial fibrillation; Medicines that help control uneven or abnormal heartbeats; Water pills (diuretics) to remove excess fluid in the lungs. […] A low-sodium diet may be helpful. You may need to limit your activity if symptoms develop. […] Once the diagnosis is made, you should visit your provider regularly to track your symptoms and heart function.

• #17 Mitral valve regurgitation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mitral-valve-regurgitation/diagnosis-treatment/drc-20350183

  The goals of mitral valve regurgitation treatment are to: […] Treatment of mitral valve regurgitation may include: […] A doctor trained in heart diseases typically provides care for people with mitral valve regurgitation. […] Medicines may be needed to reduce mitral valve regurgitation symptoms and to prevent complications of heart valve disease. […] A diseased or damaged mitral valve might eventually need to be repaired or replaced, even if you don’t have symptoms. […] Mitral valve surgery is usually done through a cut in the chest. […] In mitral valve repair, the surgeon removes and repairs part of the damaged mitral valve to allow the valve to fully close and stop leaking. […] Whenever possible, mitral valve repair is recommended before considering valve replacement. […] During mitral valve repair surgery, the surgeon might:

• #18 Mitral Valve Repair: Procedure & Recovery

  https://my.clevelandclinic.org/health/treatments/17240-mitral-valve-repair

  Mitral valve repair surgery helps people with mitral valve disease live a longer and healthier life. You may need this heart surgery if your mitral valve is very leaky or narrow. Without treatment, these problems can damage your heart over time and even be fatal. Talk with your provider about the treatment plan thats best for you. […] If you have severe mitral valve disease, your provider may recommend open-heart surgery to repair or replace your damaged valve. They often prefer repair over replacement especially when the valve leaks. This is because keeping your own valve offers more benefits and fewer risks. […] Mitral valve repair treats the following conditions: […] Mitral valve regurgitation. Your valve flaps dont close all the way, allowing some blood to leak in the wrong direction. You may need surgery if your valve is very leaky or causes symptoms.

• #19 Mitral valve regurgitation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mitral-valve-regurgitation/diagnosis-treatment/drc-20350183

  The goals of mitral valve regurgitation treatment are to: […] Treatment of mitral valve regurgitation may include: […] A doctor trained in heart diseases typically provides care for people with mitral valve regurgitation. […] Medicines may be needed to reduce mitral valve regurgitation symptoms and to prevent complications of heart valve disease. […] A diseased or damaged mitral valve might eventually need to be repaired or replaced, even if you don’t have symptoms. […] Mitral valve surgery is usually done through a cut in the chest. […] In mitral valve repair, the surgeon removes and repairs part of the damaged mitral valve to allow the valve to fully close and stop leaking. […] Whenever possible, mitral valve repair is recommended before considering valve replacement. […] During mitral valve repair surgery, the surgeon might:

• #20 Mitral Regurgitation Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/155618-treatment

  Common techniques for mitral valve repair for primary MR include nonresection techniques using artificial chords or ipsilateral chordal transfer, triangular resection with annuloplasty ring, and sliding leaflet valvuloplasty with annuloplasty ring. […] Common techniques for mitral valve repair for secondary MR include restrictive remodeling with a rigid annuloplasty ring, and chordal-sparing mitral valve replacement. […] A primary determinant of successful repair is the surgeon’s experience. For asymptomatic (stage C1) patients, patients with complex mitral pathoanatomy, and patients who desire a minimally invasive or robotic approach to mitral valve repair, consider referral to an experienced mitral surgeon at a comprehensive valve center. […] Long-term follow-up of patients after surgical or transcatheter mitral intervention is essential for the assessment of durability, functional outcomes, and survival.

• #21 Mitral Valve Repair: Procedure & Recovery

  https://my.clevelandclinic.org/health/treatments/17240-mitral-valve-repair

  People who have mitral valve disease, particularly if the valve leaks, may need mitral valve repair surgery. […] Whenever possible, your provider will recommend a repair instead of a replacement. Repair is the better option for most people with mitral valve regurgitation. […] Mitral valve repair is successful in most cases. Reports have shown that 10 years later, nearly 94% of people dont have significant mitral valve regurgitation. […] Mitral valve repair is a durable solution for treating mitral valve disease. Most people (95%) can go at least 10 years without needing another surgery. Almost as many (90%) can go 20 years. Most people dont need another mitral valve surgery after a successful repair. […] If your provider recommends surgery to repair your mitral valve, they believe the benefits of the surgery outweigh the risks.

• #22 Mitral Valve Repair: Procedure & Recovery

  https://my.clevelandclinic.org/health/treatments/17240-mitral-valve-repair

  People who have mitral valve disease, particularly if the valve leaks, may need mitral valve repair surgery. […] Whenever possible, your provider will recommend a repair instead of a replacement. Repair is the better option for most people with mitral valve regurgitation. […] Mitral valve repair is successful in most cases. Reports have shown that 10 years later, nearly 94% of people dont have significant mitral valve regurgitation. […] Mitral valve repair is a durable solution for treating mitral valve disease. Most people (95%) can go at least 10 years without needing another surgery. Almost as many (90%) can go 20 years. Most people dont need another mitral valve surgery after a successful repair. […] If your provider recommends surgery to repair your mitral valve, they believe the benefits of the surgery outweigh the risks.

• #23 Mitral valve regurgitation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mitral-valve-regurgitation/diagnosis-treatment/drc-20350183

  Other mitral valve repair procedures include: […] If a previously replaced mitral valve has a leak surrounding the artificial valve, a cardiologist may insert a device to stop the leak. […] During mitral valve replacement, the surgeon removes the mitral valve. It’s replaced with a mechanical valve or a valve made from cow, pig or human heart tissue. […] If you had mitral valve replacement with a mechanical valve, you need to take blood thinners for life to prevent blood clots.

• #24 Mitral Valve Disease (Regurgitation) | Inova

  https://www.inova.org/our-services/inova-schar-heart-and-vascular/conditions-treatments/mitral-valve-disease

  Mitral valve replacement is performed less frequently, usually in cases where the valve cannot be repaired. Options include biological (tissue valves) and mechanical valves. Biological valves are usually made from pig or cow tissue. They are easy to insert and generally last 15 to 20 years. Patients who receive tissue valves do not need to take a blood thinning medication for the rest of their lives. Mechanical valves are also easy to insert and durable, generally lasting more than 20 years. Patients who receive mechanical valves must take a blood thinning medication for the rest of their lives to prevent blood clots. […] The surgeons at Inova Schar Heart and Vascular are leaders in mitral valve repair, particularly minimally invasive techniques.

• #25 Mitral Valve Disease (Regurgitation) | Inova

  https://www.inova.org/our-services/inova-schar-heart-and-vascular/conditions-treatments/mitral-valve-disease

  Mitral valve replacement is performed less frequently, usually in cases where the valve cannot be repaired. Options include biological (tissue valves) and mechanical valves. Biological valves are usually made from pig or cow tissue. They are easy to insert and generally last 15 to 20 years. Patients who receive tissue valves do not need to take a blood thinning medication for the rest of their lives. Mechanical valves are also easy to insert and durable, generally lasting more than 20 years. Patients who receive mechanical valves must take a blood thinning medication for the rest of their lives to prevent blood clots. […] The surgeons at Inova Schar Heart and Vascular are leaders in mitral valve repair, particularly minimally invasive techniques.

• #26 Mitral valve regurgitation – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mitral-valve-regurgitation/diagnosis-treatment/drc-20350183

  Other mitral valve repair procedures include: […] If a previously replaced mitral valve has a leak surrounding the artificial valve, a cardiologist may insert a device to stop the leak. […] During mitral valve replacement, the surgeon removes the mitral valve. It’s replaced with a mechanical valve or a valve made from cow, pig or human heart tissue. […] If you had mitral valve replacement with a mechanical valve, you need to take blood thinners for life to prevent blood clots.

• #27 Mitral Valve Repair | Mitral Regurgitation

  https://www.structuralheart.abbott/patients/treatment/mitral-valve-repair

  If mitral valve repair is an option for you, a surgical technique called an annuloplasty may be performed. This procedure typically involves the implantation of a device to tighten or replace the ring around the mitral valve (annulus) so that the valve leaflets can close properly. […] TEER with MitraClip therapy is a minimally invasive procedure that may be an option for people with severe mitral regurgitation. Unlike surgery, this procedure does not require chest incisions and temporarily stopping the heart. In this procedure, a small implanted clip is attached to your mitral leaflet (accessed through a vein in your leg) to help it close more completely. This helps to restore normal blood flow through your heart. […] MitraClip therapy is a minimally invasive procedure approved for treating patients with clinically significant mitral regurgitation due to either (a) a deteriorated mitral valve in patients who are deemed to be at prohibitive risk for surgery, or (b) mitral valve in patients who have heart failure and an enlarged heart who remain symptomatic on maximally tolerated medications to treat their heart failure.

• #28 Transcatheter Heart Valve Therapies for the Mitral Valve | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/treatments/transcatheter-heart-valve-therapies-for-mitral-valve

  As one of the highest volume and most experienced transcatheter mitral valve programs in the nation, Northwestern Medicine continues to expand its Transcatheter Heart Valve Program by offering a wide array of minimally invasive commercially available and clinical trial options to treat the mitral valve, including MitraClip. […] For some patients with mitral valve disease, transcatheter heart valve therapies, like MitraClip, are an alternative treatment to open heart valve surgery. […] In 2013, the U.S. FDA approved MitraClip for patients with degenerative or primary mitral regurgitation caused by disease of the mitral valve. […] As a result of these findings, the FDA approved MitraClip for patients with functional or secondary mitral regurgitation caused by diminished heart function. This approval has significantly expanded the number of people who can be treated with MitraClip.

• #29 Transcatheter Heart Valve Therapies for the Mitral Valve | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/treatments/transcatheter-heart-valve-therapies-for-mitral-valve

  Transcatheter procedures allow the procedure to be performed while the patients heart is still beating, eliminating the need for a heart bypass machine and its associated risks. […] MitraClip: A minimally invasive treatment option for patients with mitral regurgitation. […] During MitraClip implantation, an interventional cardiologist inserts a catheter (tube) in the body through the femoral (groin) vein. […] The MitraClip device is positioned to join or clip together a portion of the mitral valve, reducing or eliminating the backward flow of blood. […] Transcatheter Mitral Valve in Valve Replacement: A minimally invasive TMVR procedure for patients who have had previous open heart valve surgery to replace the mitral valve with a bioprosthetic/tissue valve and the valve is now failing. […] The TMVR valve is compressed and advanced by a catheter through a vein until it reaches the failing mitral valve. […] The PASCAL System and the MitraClip System are designed to reduce the amount of mitral regurgitation without the need for surgery (less invasive).

• #30 Transcatheter Heart Valve Therapies for the Mitral Valve | Northwestern Medicine

  https://www.nm.org/conditions-and-care-areas/treatments/transcatheter-heart-valve-therapies-for-mitral-valve

  Transcatheter procedures allow the procedure to be performed while the patients heart is still beating, eliminating the need for a heart bypass machine and its associated risks. […] MitraClip: A minimally invasive treatment option for patients with mitral regurgitation. […] During MitraClip implantation, an interventional cardiologist inserts a catheter (tube) in the body through the femoral (groin) vein. […] The MitraClip device is positioned to join or clip together a portion of the mitral valve, reducing or eliminating the backward flow of blood. […] Transcatheter Mitral Valve in Valve Replacement: A minimally invasive TMVR procedure for patients who have had previous open heart valve surgery to replace the mitral valve with a bioprosthetic/tissue valve and the valve is now failing. […] The TMVR valve is compressed and advanced by a catheter through a vein until it reaches the failing mitral valve. […] The PASCAL System and the MitraClip System are designed to reduce the amount of mitral regurgitation without the need for surgery (less invasive).

• #31 Less-Invasive Treatment Offers Alternative for Mitral Valve Regurgitation Patients – Medical Update

  https://medicalupdate.pennstatehealth.org/cardiology/alternative-mitral-valve-treatment/

  Mitral regurgitation (MR) is the most frequently reported valve disease in the United States, twice as common as aortic valve disease. […] Interventional cardiologist Pradeep Yadav, MD, Penn State Heart and Vascular Institute, along with his structural heart team at Penn State Health Milton S. Hershey Medical Center, has opened the door to valve repair for many patients by offering a less invasive procedure using the MitraClip system. […] The MitraClip procedure provides a viable option to patients even those older than 80 years of age who otherwise would not be a candidate for open heart surgery and could only be treated medically. […] Patients are ambulatory within hours, often get discharged the next day, have fewer heart failure-related hospitalizations and report better quality of life, due to less mitral regurgitation.

• #32 Transcatheter Therapies for FMR | ICR Journal

  https://www.icrjournal.com/articles/transcatheter-treatment-options-functional-mitral-regurgitation-which-device-which?language_content_entity=en

  Considering the results of both the MITRA-FR and COAPT trials, it appears reasonable to conclude that the MitraClip procedure reduces heart failure hospitalisation and mortality in patients meeting the following criteria: moderate-to-severe secondary MR defined as EROA 30 mm2 and/or regurgitant volume 45 ml; LV ejection fraction (LVEF) 2050% and LV end-systolic diameter (LVESD) 70 mm; and persistent heart failure symptoms defined as NYHA class II despite optimal GDMT. […] The PASCAL mitral valve repair system (Edwards Lifesciences) uses a transseptal approach and edge-to-edge repair technique combined with a central spacer to fill the regurgitant orifice area. […] The CLASP IID/IIF is an ongoing prospective multicentre randomised controlled pivotal trial that aims to establish the safety and effectiveness of the PASCAL mitral repair system compared with MitraClip in patients with DMR deemed at prohibitive risk for mitral valve surgery and patients with FMR optimised on GDMT.

• #33

  https://www.beaumont.org/conditions/mitral-valve-regurgitation

  Mitral valve regurgitation treatment options may include medication, catheter-based procedure, minimally invasive valve surgery or open-heart surgery. A specific treatment will be determined by your doctor based on: […] Mitral valve regurgitation cannot be corrected with medication, but it may be prescribed to relieve or control the symptoms. […] Some patients may benefit from catheter-based procedures like the MitraClip, which is a catheter treatment option for high-risk mitral valve regurgitation patients. […] Transcatheter Mitral Valve Replacement (TMVR) is another option for patients with mitral valve disease (mitral valve stenosis or mitral valve regurgitation). […] Some patients may be recommended for a surgical approach. Beaumont’s cardiac surgeons can repair or replace a mitral valve using minimally invasive heart surgery through a small two to three-inch incision. […] These different techniques are proven and effective way of eliminating mitral regurgitation and improving symptoms of heart failure.

• #34 Mitral valve regurgitation Information | Mount Sinai – New York

  https://www.mountsinai.org/health-library/diseases-conditions/mitral-valve-regurgitation

  You may need surgery to repair or replace the valve if: Heart function is poor; The heart becomes enlarged (dilated); Symptoms get worse. […] Catheter based non-surgical techniques to place clips or replace the mitral valve are increasingly in use for some selected patients with mitral regurgitation.

• #35 Mitral Regurgitation: Causes and Treatment | Doctor

  https://patient.info/doctor/mitral-regurgitation-pro

  When heart failure has developed, angiotensin-converting enzyme (ACE) inhibitors should be considered in patients with advanced MR and severe symptoms, who are not suitable for surgery or have residual symptoms following surgery. Beta-blockers and spironolactone are also appropriate. […] Urgent surgery is indicated in patients with acute severe MR. […] Surgery is indicated in patients with severe chronic primary MR who have symptoms due to chronic MR, but no contra-indications to surgery. […] Valve repair is considered to be the preferred surgical treatment in patients with severe MR. When compared with valve replacement, repair has a lower perioperative mortality, improved survival, better preservation of postoperative LV function and lower long-term morbidity. […] When repair is not possible, mitral valve replacement with preservation of the subvalvular apparatus is preferred.

• #36 Mitral Regurgitation: Causes and Treatment | Doctor

  https://patient.info/doctor/mitral-regurgitation-pro

  Consider referring adults with asymptomatic severe primary mitral regurgitation for intervention, if suitable, if they have any of the following: Left ventricular ejection fraction (LVEF) less than 60%, End systolic diameter (ESD) more than 45 mm or end systolic diameter index (ESDI) more than 22 mm/m2 on echocardiography; or An increase of systolic pulmonary artery pressure to more than 60 mm Hg on exercise testing. […] Offer surgical mitral valve repair (by median sternotomy or minimally invasive surgery) to adults with severe primary mitral regurgitation and an indication for repair, if surgery is suitable. […] Offer surgical mitral valve replacement (by median sternotomy or minimally invasive surgery) to adults with severe primary mitral regurgitation and an indication for surgery, if the valve is not suitable for repair and surgery is suitable.

• #37 Mitral Regurgitation: Causes and Treatment | Doctor

  https://patient.info/doctor/mitral-regurgitation-pro

  Mitral regurgitation treatment and management is a critical aspect of addressing this condition. Medical therapy, surgical mitral valve repair or replacement, and, in the setting of advanced heart failure, heart transplant and left ventricular assist devices remain the mainstay of treatment. […] The management of asymptomatic patients is controversial but surgery may be an option in selected asymptomatic patients with severe MR. […] Surgery is indicated in patients with signs of LV dysfunction. If LV function is preserved, surgery should be considered in asymptomatic patients with new-onset atrial fibrillation or pulmonary hypertension. […] When surgery is appropriate, early surgery (ie within two months) is associated with better outcomes, since the development of even mild symptoms by the time of surgery is associated with adverse changes in cardiac function after surgery.

• #38 Mitral Valve Regurgitation Information & Treatment

  https://www.columbiadoctors.org/health-library/condition/mitral-valve-regurgitation/

  For chronic mitral regurgitation, you may take medicines to treat problems caused by the regurgitation or to treat a heart problem that is causing it. Your doctor will check your heart regularly. You may choose to repair or replace the valve. For acute regurgitation, you likely need valve repair or replacement right away. […] Treatment for chronic mitral valve regurgitation includes regular tests to check how well the valve and the heart are working. You may take medicine to treat problems caused by the regurgitation. Or you may take medicine to treat a heart problem that’s causing it. Your doctor will likely recommend a heart-healthy lifestyle. […] If your condition becomes severe, you may choose to have the valve repaired or replaced. You and your doctor can talk about a few things to decide. These things include the cause of the regurgitation, the anatomy of the valve, if you have symptoms, how well your heart is pumping blood, and your feelings about having surgery or a procedure.

• #39 Mitral Regurgitation Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/155618-treatment

  Key considerations regarding treatment from the 2017 American College of Cardiology (ACC) expert consensus decision pathway on the management of mitral regurgitation (MR) include the following: […] Decisions regarding the optimal treatment of chronic MR are based on multiple variables, including MR type, MR severity, hemodynamic consequences, disease stage, patient comorbidities, and the experience of the heart valve team and its members. […] The principal intervention for primary MR is surgery; however, transcatheter mitral valve repair using an edge-to-edge clip plays a very limited role. Whenever feasible, mitral valve repair is strongly preferred over mitral valve replacement for primary MR. […] Surgical treatment for secondary MR should be considered only after appropriate medical and device therapies have been instituted.

• #40 Mitral Regurgitation Topic Review

  https://www.healio.com/cardiology/learn-the-heart/cardiology-review/topic-reviews/mitral-regurgitation

  Appropriate treatment of mitral regurgitation requires an accurate diagnosis and should be based on the natural history of the underlying disease process. […] Recent studies of percutaneous mitral valve repair have fundamentally altered the management of secondary mitral regurgitation based on the concept of proportionate and disproportionate mitral regurgitation. The data indicate that patients with disproportionate MR have larger effective regurgitant orifice areas and lower LV volumes benefit from (percutaneous) valve repair, whereas those with proportionate MR do not. […] With primary mitral regurgitation, due to the potential complications of prosthetic valves, mitral valve repair is the surgical intervention of choice. When echocardiographic data indicate that mitral valve repair is feasible, a lower threshold for surgery may be considered.

• #41 Management of secondary mitral regurgitation: from drugs to devices | Heart

  https://heart.bmj.com/content/110/17/1099

  To slow the rapid accumulation of morbidity and mortality, we advocate a proactive approach with accelerated medical optimisation, followed by management of atrial fibrillation and cardiac resynchronisation therapy if indicated, then, rapid referral to the Heart Team for consideration of mitral valve intervention in patients with ongoing symptoms and at least moderate-severe mitral regurgitation. […] The mainstay of treatment remains optimal medical therapy, as this can improve MR, and may even resolve it altogether in some patients. […] Transcatheter mitral intervention, predominantly transcatheter edge-to-edge repair (TEER), has expanded treatment options for this group of patients. […] The management of AF is an important part of the optimisation of patients with VsMR. […] For this reason, it is crucial that patients who do not fully respond to medical therapy are referred early for consideration of other therapies including mitral valve intervention.

• #42 Management of secondary mitral regurgitation: from drugs to devices | Heart

  https://heart.bmj.com/content/110/17/1099

  Severe secondary mitral regurgitation carries a poor prognosis with one in five patients dying within 12 months of diagnosis. Fortunately, there are now a number of safe and effective therapies available to improve outcomes. Here, we summarise the most up-to-date treatments. Optimal guideline-directed medical therapy is the mainstay therapy and has been shown to reduce the severity of mitral regurgitation in 4045% of patients. […] The pursuit of sinus rhythm in patients with atrial fibrillation has been shown to significantly reduce mitral regurgitation severity, as has the use of cardiac resynchronisation devices in patients who meet guideline-directed criteria. […] Finally, we highlight the key role of mitral valve intervention, particularly transcatheter edge-to-edge repair (TEER) for management of moderate-severe mitral regurgitation in carefully selected patients with poor left ventricular systolic function, with a number needed to treat of 3.1 to reduce heart failure hospitalisation and 5.9 to reduce all-cause death.

• #43 Management of secondary mitral regurgitation: from drugs to devices | Heart

  https://heart.bmj.com/content/110/17/1099

  Mitral TEER has been shown to be reasonably cost-effective (but not cost-saving) in the UK in selected patients, although TEER remains underused with only 6.5 procedures per million population (pmp) compared with Germany (77 pmp), Switzerland (44 pmp) and the USA (32 pmp). […] Guidelines have upgraded the role of m-TEER in the management of VsMR (class IIA/level B). m-TEER can be recommended in patients fulfilling the COAPT trial inclusion criteria who are not eligible for surgery. […] Patients who fulfil the COAPT criteria should be referred for m-TEER. […] Based on the data presented above, if we take this approach, we will significantly reduce mortality and morbidity in this important patient group.

• #44 Management of secondary mitral regurgitation: from drugs to devices | Heart

  https://heart.bmj.com/content/110/17/1099

  Mitral TEER has been shown to be reasonably cost-effective (but not cost-saving) in the UK in selected patients, although TEER remains underused with only 6.5 procedures per million population (pmp) compared with Germany (77 pmp), Switzerland (44 pmp) and the USA (32 pmp). […] Guidelines have upgraded the role of m-TEER in the management of VsMR (class IIA/level B). m-TEER can be recommended in patients fulfilling the COAPT trial inclusion criteria who are not eligible for surgery. […] Patients who fulfil the COAPT criteria should be referred for m-TEER. […] Based on the data presented above, if we take this approach, we will significantly reduce mortality and morbidity in this important patient group.

• #45 Minimally Invasive Mitral Valve Repair

  https://www.massgeneral.org/heart-center/treatments-and-services/minimally-invasive-mitral-valve-repair

  Not all patients are candidates for the minimally invasive mitral valve repair approach. Some might require another procedure on their heart, such as a coronary artery bypass grafting procedure, and therefore would need to undergo their surgery through a traditional sternotomy approach. […] The surgery itself is safe and carries a low complication rate. The success rate is similar to conventional mitral valve repair. More than 95% patients who underwent minimally invasive mitral valve surgery at Mass General had a successful mitral valve repair. […] Patients meet with members of the Heart Valve Program care team to discuss the best treatment approach. […] After the surgery, the patient generally stays one to two days in the intensive care unit and two to four days on the regular postoperative floor. Patients are given clear instructions prior to the discharge home or to rehabilitation as well as a follow-up appointment with the surgeon and their cardiologist.

• #46 Minimally Invasive Mitral Valve Repair

  https://www.massgeneral.org/heart-center/treatments-and-services/minimally-invasive-mitral-valve-repair

  Not all patients are candidates for the minimally invasive mitral valve repair approach. Some might require another procedure on their heart, such as a coronary artery bypass grafting procedure, and therefore would need to undergo their surgery through a traditional sternotomy approach. […] The surgery itself is safe and carries a low complication rate. The success rate is similar to conventional mitral valve repair. More than 95% patients who underwent minimally invasive mitral valve surgery at Mass General had a successful mitral valve repair. […] Patients meet with members of the Heart Valve Program care team to discuss the best treatment approach. […] After the surgery, the patient generally stays one to two days in the intensive care unit and two to four days on the regular postoperative floor. Patients are given clear instructions prior to the discharge home or to rehabilitation as well as a follow-up appointment with the surgeon and their cardiologist.

• #47 Mitral Valve Disease Treatment and Recovery | AdventHealth Orlando

  https://www.adventhealth.com/hospital/adventhealth-orlando/blog/mitral-valve-disease-treatment-and-recovery

  Minimally invasive surgery is performed with small incisions and special small tools. A valve replacement surgery performed this way is faster, easier and requires less recovery time. […] Before the surgery, you and your doctor will talk about what kind of valve will work best for you. You may be given a biological valve. This is a valve made from cow, pig or human heart tissue. Or, you may be given a mechanical valve. This is an artificial valve made from metal and other materials. […] Most people who have mitral valve replacement notice immediate symptom relief after their surgery. […] After you go home, take your temperature, monitor your blood pressure and weigh yourself every day. Keep records and call your health care provider with any significant or concerning changes. […] Follow all of the instructions your health care provider gives you for driving, medicines, exercise, diet, and wound care. If you have a mechanical valve, youll likely need to take blood-thinning medicine, and some may require blood tests to check the how the medicine is working.

• #48 Mitral Valve Disease Treatment and Recovery | AdventHealth Orlando

  https://www.adventhealth.com/hospital/adventhealth-orlando/blog/mitral-valve-disease-treatment-and-recovery

  Minimally invasive surgery is performed with small incisions and special small tools. A valve replacement surgery performed this way is faster, easier and requires less recovery time. […] Before the surgery, you and your doctor will talk about what kind of valve will work best for you. You may be given a biological valve. This is a valve made from cow, pig or human heart tissue. Or, you may be given a mechanical valve. This is an artificial valve made from metal and other materials. […] Most people who have mitral valve replacement notice immediate symptom relief after their surgery. […] After you go home, take your temperature, monitor your blood pressure and weigh yourself every day. Keep records and call your health care provider with any significant or concerning changes. […] Follow all of the instructions your health care provider gives you for driving, medicines, exercise, diet, and wound care. If you have a mechanical valve, youll likely need to take blood-thinning medicine, and some may require blood tests to check the how the medicine is working.

• #49 Mitral Valve Disease Treatment and Recovery | AdventHealth Orlando

  https://www.adventhealth.com/hospital/adventhealth-orlando/blog/mitral-valve-disease-treatment-and-recovery

  Keep all your follow-up appointments and follow your health care provider’s suggestions about beginning a cardiac rehabilitation program, which begins in the hospital with simple walking and progresses to a regular exercise routine. It also includes education about eating a nutritious diet. Committing to healthier habits can prevent future heart problems.

• #50 Management of secondary mitral regurgitation: from drugs to devices | Heart

  https://heart.bmj.com/content/110/17/1099

  Severe secondary mitral regurgitation carries a poor prognosis with one in five patients dying within 12 months of diagnosis. Fortunately, there are now a number of safe and effective therapies available to improve outcomes. Here, we summarise the most up-to-date treatments. Optimal guideline-directed medical therapy is the mainstay therapy and has been shown to reduce the severity of mitral regurgitation in 4045% of patients. […] The pursuit of sinus rhythm in patients with atrial fibrillation has been shown to significantly reduce mitral regurgitation severity, as has the use of cardiac resynchronisation devices in patients who meet guideline-directed criteria. […] Finally, we highlight the key role of mitral valve intervention, particularly transcatheter edge-to-edge repair (TEER) for management of moderate-severe mitral regurgitation in carefully selected patients with poor left ventricular systolic function, with a number needed to treat of 3.1 to reduce heart failure hospitalisation and 5.9 to reduce all-cause death.

• #51 Mitral Valve Disease: Types, Symptoms and Treatment

  https://my.clevelandclinic.org/health/diseases/23235-mitral-valve-disease

  Percutaneous interventions. These catheter-based procedures are often a good fit for people who have an enlarged heart, a weak heart or other health problems. If you have mitral valve regurgitation, you may be a candidate for a MitraClip device. This dime-sized device can be implanted on your mitral valve to help it close better and prevent your blood from flowing backward. […] Talk with your provider about the treatment option that’s best for you. Many factors affect your treatment plan, including: What form of mitral valve disease you have. Your age. Your health history. Your current health condition. Whether you have other heart issues that need to be repaired at the same time. […] Surgeries and procedures to treat mitral valve disease are generally very successful. The risk of complications is low. Possible complications are similar to those for other heart procedures, and include: Arrhythmia. Bleeding. Blood clots. Heart attack. Heart block. Infection.

• #52 Mitral Valve Disease Treatment and Recovery | AdventHealth Orlando

  https://www.adventhealth.com/hospital/adventhealth-orlando/blog/mitral-valve-disease-treatment-and-recovery

  Minimally invasive surgery is performed with small incisions and special small tools. A valve replacement surgery performed this way is faster, easier and requires less recovery time. […] Before the surgery, you and your doctor will talk about what kind of valve will work best for you. You may be given a biological valve. This is a valve made from cow, pig or human heart tissue. Or, you may be given a mechanical valve. This is an artificial valve made from metal and other materials. […] Most people who have mitral valve replacement notice immediate symptom relief after their surgery. […] After you go home, take your temperature, monitor your blood pressure and weigh yourself every day. Keep records and call your health care provider with any significant or concerning changes. […] Follow all of the instructions your health care provider gives you for driving, medicines, exercise, diet, and wound care. If you have a mechanical valve, youll likely need to take blood-thinning medicine, and some may require blood tests to check the how the medicine is working.

• #53 Mitral Valve Regurgitation Treatment | Tampa General Hospital

  https://www.tgh.org/institutes-and-services/treatments/mitral-regurgitation

  MitraClip. Patients who aren’t candidates for open-heart valve surgery may be eligible for MitraClip, a V-shaped clip that attaches to a mitral valve leaflet to reduce leakage. […] The benefits of mitral valve regurgitation treatment include preserving heart function, improving your symptoms and having a better quality of life. […] Mitral valve repair is a highly effective treatment for mitral valve regurgitation, with a majority of patients not needing a second operation to repair the valve. […] Mitral valve replacement is also very effective, although biological tissue valves may degenerate over time and the procedure may need to be repeated.

• #54 Mitral Regurgitation Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/155618-treatment

  A study using data from the Mitral Regurgitation International Database (MIDA) found that patients with severe MR without a class I indication for surgical intervention fared significantly better when they were treated with surgery than when they underwent watchful waiting while being treated with medical therapy. […] Inotropic agents should be considered in chronic severely symptomatic MR, and consultation with a specialist in cardiothoracic surgery should be obtained. […] Surgery is recommended for moderate to severe (grade 3) mitral regurgitation (MR) in symptomatic patients or those with left ventricular (LV) dysfunction. […] The risks and benefits of surgery should be assessed based on the age and comorbidity of each individual patient, with the decision to proceed or not to proceed being grounded in uniformly accepted guidelines.

• #55 How to manage mitral valve regurgitation

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-6/How-to-manage-mitral-valve-regurgitation

  To conclude, the quality of mitral regurgitation management may be improved. Follow-up examinations should be performed at regular intervals in standardized conditions. […] Finally, mitral valve surgery should be performed in dedicated centers and in the hands of a dedicated team of heart surgeons.

• #56 How to manage mitral valve regurgitation

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-6/How-to-manage-mitral-valve-regurgitation

  The optimal management of mitral regurgitation may be challenging. For patients with severe regurgitation, particular care needs to be paid to the quality of follow-up while they are still asymptomatic, and it is best performed in specialised centers (at 6 monthly intervals). […] Mitral valve surgery is also best performed in high volume centers with a dedicated team of heart surgeons. […] Considering these issues, attempts should be undertaken to improve of the care of these patients. […] When managing a patient with valvular mitral regurgitation the following considerations need to be taken into account: The natural history of the disease, Preoperative determinants of postoperative outcome, The morphology of the mitral valve itself and the likelihood of achieving a successful mitral valve repair (versus replacement), Operative Risk for the individual patient in a specific center, The overall outcome with regard to survival and morbidity of the chosen treatment strategy.

• #57 How to manage mitral valve regurgitation

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-6/How-to-manage-mitral-valve-regurgitation

  The optimal management of mitral regurgitation may be challenging. For patients with severe regurgitation, particular care needs to be paid to the quality of follow-up while they are still asymptomatic, and it is best performed in specialised centers (at 6 monthly intervals). […] Mitral valve surgery is also best performed in high volume centers with a dedicated team of heart surgeons. […] Considering these issues, attempts should be undertaken to improve of the care of these patients. […] When managing a patient with valvular mitral regurgitation the following considerations need to be taken into account: The natural history of the disease, Preoperative determinants of postoperative outcome, The morphology of the mitral valve itself and the likelihood of achieving a successful mitral valve repair (versus replacement), Operative Risk for the individual patient in a specific center, The overall outcome with regard to survival and morbidity of the chosen treatment strategy.

• #58 Mitral Regurgitation Treatment & Management: Approach Considerations, Medical Care, Surgical Care

  https://emedicine.medscape.com/article/155618-treatment

  Common techniques for mitral valve repair for primary MR include nonresection techniques using artificial chords or ipsilateral chordal transfer, triangular resection with annuloplasty ring, and sliding leaflet valvuloplasty with annuloplasty ring. […] Common techniques for mitral valve repair for secondary MR include restrictive remodeling with a rigid annuloplasty ring, and chordal-sparing mitral valve replacement. […] A primary determinant of successful repair is the surgeon’s experience. For asymptomatic (stage C1) patients, patients with complex mitral pathoanatomy, and patients who desire a minimally invasive or robotic approach to mitral valve repair, consider referral to an experienced mitral surgeon at a comprehensive valve center. […] Long-term follow-up of patients after surgical or transcatheter mitral intervention is essential for the assessment of durability, functional outcomes, and survival.

• #59 Management of secondary mitral regurgitation: from drugs to devices | Heart

  https://heart.bmj.com/content/110/17/1099

  To slow the rapid accumulation of morbidity and mortality, we advocate a proactive approach with accelerated medical optimisation, followed by management of atrial fibrillation and cardiac resynchronisation therapy if indicated, then, rapid referral to the Heart Team for consideration of mitral valve intervention in patients with ongoing symptoms and at least moderate-severe mitral regurgitation. […] The mainstay of treatment remains optimal medical therapy, as this can improve MR, and may even resolve it altogether in some patients. […] Transcatheter mitral intervention, predominantly transcatheter edge-to-edge repair (TEER), has expanded treatment options for this group of patients. […] The management of AF is an important part of the optimisation of patients with VsMR. […] For this reason, it is crucial that patients who do not fully respond to medical therapy are referred early for consideration of other therapies including mitral valve intervention.

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