Mitral Valve Repair or Replacement. How long is this feud to last?
Choosing to perform mitral valve (MV) repair or replacement remains a
hot and highly debated topic. The current guidelines seem to be
conflicting in this specific field and the evidences at our disposal are
scarce, only one small randomized trial and few larger retrospective
studies. The meta-analysis by Gamal and coworkers tries to summarize the
current evidences, concluding that MV replacement for the treatment of
ischemic mitral regurgitation is at least as safe as repair and
certainly offers a more stable result over time than the latter.
Obviously, the implantation of a prosthesis, especially a mechanical
one, brings with it a series of problems, such as anticoagulation and,
above all, a possible lack of ventricular remodeling, especially if a
chordal sparing replacement is not performed. It must be said, on the
other hand, that isolated annuloplasty cannot act as a counterpart to
replacement, because ischemic MR cannot be considered only an annular
disease. Therefore, wanting to mimic the nature that, after an
infarction, enacts a series of changes involving also the mitral
leaflets and chordae, the surgeons are called to act also on these two
entities and not only to downsize the annulus. In a nutshell, a
procedure should not be opposed in a fundamentalist way to another one,
but we must accept the concept of armamentarium where both procedures
are present and tail on the single patient, and also on the surgeon’s
expertise, the technique guaranteeing the best possible result.