Difference between revisions of "Mitral valve repair or replacement"
Zining Chen (talk | contribs) (Completed infobox) |
Zining Chen (talk | contribs) (Added TMVR comparison in indications section) |
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Mitral valve repair or replacement is performed for severe mitral regurgitation (MR), mitral stenosis (MS), or mixed disease. Repair is preferred when possible because it preserves annular-ventricular continuity, maintains LV geometry, improves long-term survival, and avoids prosthetic complications. Replacement is performed when repair is not durable or technically feasible (severe calcifications, rheumatic disease, extensive endocarditis). | Mitral valve repair or replacement is performed for severe mitral regurgitation (MR), mitral stenosis (MS), or mixed disease. Repair is preferred when possible because it preserves annular-ventricular continuity, maintains LV geometry, improves long-term survival, and avoids prosthetic complications. Replacement (SMVR) is performed when repair is not durable or technically feasible (severe calcifications, rheumatic disease, extensive endocarditis). | ||
== Overview == | == Overview == | ||
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=== Indications<!-- List and/or describe the indications for this surgical procedure. --> === | === Indications<!-- List and/or describe the indications for this surgical procedure. --> === | ||
* Symptomatic severe primary MR | * Symptomatic severe primary (degenerative) MR | ||
* Severe secondary MR with persistent symptoms despite GDMT | *Symptomatic severe MS | ||
* Severe | * Severe secondary (functional) MR with persistent symptoms despite GDMT | ||
* Severe MR with LV dilation or LV dysfunction | |||
*Recurrent MR after primary repair | |||
* Endocarditis with structural destruction | * Endocarditis with structural destruction | ||
* Concomitant need during CABG or other valve surgery | * Concomitant need during CABG or other valve surgery | ||
Unlike Transcatheter mitral valve repair/replacement, SMVR allows: | |||
* Complete annular debridement | |||
* Abscess debridement | |||
* Annular enlargement | |||
* Leaflet resection and chordal reconstruction | |||
* Preservation of subvalvular apparatus | |||
* Concomitant procedures like MAZE, left atrial appendage excision, tricuspid repair, or CABG | |||
* Durability advantage in primary MR in low risk patients | |||
Transcatheter mitral valve repair/replacement (TMVR) is preferred in: | |||
* Elderly patients | |||
* High or prohibitive surgical risk | |||
* Frailty or hostile chest | |||
=== Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> === | === Surgical procedure<!-- Briefly describe the major steps of this surgical procedure. --> === | ||
Revision as of 08:12, 2 March 2026
| Anesthesia type |
General |
|---|---|
| Airway |
ETT |
| Lines and access |
PIV, Arterial line, Central line, +/- PA catheter |
| Monitors |
Standard ASA, arterial line BP, CVP +/- PAP, TEE, NIRS |
| Primary anesthetic considerations | |
| Preoperative |
-Severity and mechanism of lesion (MS vs MR, primary vs secondary) -LV size and systolic function -Pulmonary HTN, RV function -Chronic atrial fibrillation -Thromboemoblism risk (LA thrombus) -Concomitant procedures (CABG, MAZE, multi valves) |
| Intraoperative |
-Hemodynamic goals (MS vs MR) -Full heparinization before CPB -Myocardial protection and de-airing -Conduction disturbances -Weaning from CPB: LV/RV function, valve seating, gradients |
| Postoperative |
-RV failure -SAM -Atrial fibrillation -Low cardiac output syndrome -Bleeding |
| Article quality | |
| Editor rating | |
| User likes | 0 |
Mitral valve repair or replacement is performed for severe mitral regurgitation (MR), mitral stenosis (MS), or mixed disease. Repair is preferred when possible because it preserves annular-ventricular continuity, maintains LV geometry, improves long-term survival, and avoids prosthetic complications. Replacement (SMVR) is performed when repair is not durable or technically feasible (severe calcifications, rheumatic disease, extensive endocarditis).
Overview
Indications
- Symptomatic severe primary (degenerative) MR
- Symptomatic severe MS
- Severe secondary (functional) MR with persistent symptoms despite GDMT
- Severe MR with LV dilation or LV dysfunction
- Recurrent MR after primary repair
- Endocarditis with structural destruction
- Concomitant need during CABG or other valve surgery
Unlike Transcatheter mitral valve repair/replacement, SMVR allows:
- Complete annular debridement
- Abscess debridement
- Annular enlargement
- Leaflet resection and chordal reconstruction
- Preservation of subvalvular apparatus
- Concomitant procedures like MAZE, left atrial appendage excision, tricuspid repair, or CABG
- Durability advantage in primary MR in low risk patients
Transcatheter mitral valve repair/replacement (TMVR) is preferred in:
- Elderly patients
- High or prohibitive surgical risk
- Frailty or hostile chest
Surgical procedure
Preoperative management
Patient evaluation
| System | Considerations |
|---|---|
| Airway | |
| Neurologic | |
| Cardiovascular | |
| Pulmonary | |
| Gastrointestinal | |
| Hematologic | |
| Renal | |
| Endocrine | |
| Other |
Labs and studies
Operating room setup
Patient preparation and premedication
Regional and neuraxial techniques
Intraoperative management
Monitoring and access
Induction and airway management
Positioning
Maintenance and surgical considerations
Emergence
Postoperative management
Disposition
Pain management
Potential complications
Procedure variants
| Variant 1 | Variant 2 | |
|---|---|---|
| Unique considerations | ||
| Indications | ||
| Position | ||
| Surgical time | ||
| EBL | ||
| Postoperative disposition | ||
| Pain management | ||
| Potential complications |
References
Top contributors: Zining Chen