Mitral valve repair or replacement

Mitral valve repair or replacement

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	Unrated
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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 (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

Preoperative management

Patient evaluation

System	Considerations
Airway
Neurologic
Cardiovascular
Pulmonary
Gastrointestinal
Hematologic
Renal
Endocrine
Other

Procedure variants

	Variant 1	Variant 2
Unique considerations
Indications
Position
Surgical time
EBL
Postoperative disposition
Pain management
Potential complications