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Mitral Valve Repair or Replacement. How long is this feud to last?
  • +2
  • Michele Di Mauro,
  • Marco Cargoni,
  • Roberta Liberi,
  • Roberto Lorusso,
  • Antonio Calafiore
Michele Di Mauro
Maastricht UMC+
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Marco Cargoni
Mazzini Hospital
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Roberta Liberi
SS Annunziata Hospital
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Roberto Lorusso
Maastricht University Medical Centre
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Antonio Calafiore
Henry Dunant Hospital Center
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Abstract

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.
20 Mar 2022Submitted to Journal of Cardiac Surgery
21 Mar 2022Assigned to Editor
21 Mar 2022Submission Checks Completed
21 Mar 2022Editorial Decision: Accept
Jun 2022Published in Journal of Cardiac Surgery volume 37 issue 6 on pages 1599-1601. 10.1111/jocs.16479