From the Guidelines
Mitral valve repair is the preferred treatment for severe primary mitral regurgitation when the results are expected to be durable. The treatment for mitral valve regurgitation depends on the severity of the condition and the presence of symptoms. For mild cases, regular monitoring without specific treatment may be sufficient. Medications are often prescribed to manage symptoms and prevent complications, including ACE inhibitors, beta-blockers, and diuretics to reduce fluid retention. Anticoagulants may be needed if atrial fibrillation develops.
Key Considerations
- For severe or symptomatic cases, surgical intervention is typically recommended, with options including mitral valve repair or replacement with mechanical or biological valves 1.
- Minimally invasive procedures like MitraClip may be suitable for high-risk surgical patients.
- The choice between repair and replacement depends on valve anatomy, patient age, and other factors.
- Repair preserves heart function better by maintaining the natural valve structure, while replacement may be necessary when repair isn't feasible.
- Patients should also adopt lifestyle modifications including sodium restriction, regular moderate exercise, smoking cessation, and management of underlying conditions like hypertension.
Surgical Indications
- Surgery is indicated in symptomatic patients with LVEF >30% and LVESD <55 mm 1.
- Surgery is indicated in asymptomatic patients with LV dysfunction (LVESD ≥45 mm and/or LVEF ≤60%) 1.
- The preference for MV repair over MV replacement is clearly stated in both American and European guidelines 1.
Transcatheter Edge-to-Edge Repair
- Transcatheter edge-to-edge repair (TEER) may be considered as an alternative to MV surgery only in patients with symptomatic severe PMR and LV dysfunction and considered to be at high/prohibitive risk for surgery by the heart team 1.
From the Research
Treatment Options for Mitral Valve Regurgitation
The treatment for mitral valve regurgitation (MR) can vary depending on the severity and underlying cause of the condition. Some of the treatment options include:
- Medical therapy: beta-blockers and renin-angiotensin-aldosterone system inhibitors have been shown to have beneficial effects in patients with moderate to severe MR 2.
- Transcatheter mitral valve intervention: this is an effective treatment option for symptomatic severe MR in patients who are considered to be inoperable or at high operative risk for surgical mitral valve surgery 3.
- Mitral valve repair: this is the treatment of choice for patients with severe primary nonrheumatic MR, and can lead to a normal lifestyle and life span if performed successfully and properly timed 4.
- Mitral valve replacement: this is an alternative to repair, but current guidelines prefer mitral valve repair over replacement for patients with nonrheumatic MR 4.
Considerations for Treatment
When considering treatment for MR, it is essential to take into account the underlying anatomy and pathophysiology of the mitral valve, as well as the severity of the regurgitation 5, 6. A heart team-based approach can help to identify the best treatment option for each patient, and may involve a combination of medical therapy, transcatheter intervention, and surgical repair or replacement.
Importance of Early Treatment
Early treatment of MR is crucial to prevent long-term complications and improve patient outcomes 5, 6. General physicians and cardiologists should be aware of the available treatment options and refer patients to dedicated centers of excellence for further evaluation and treatment. By taking a tailored approach to treatment, patients with MR can benefit from improved survival and quality of life.