Management of Moderate Mitral Valve Regurgitation

Critical Understanding of EF in Mitral Regurgitation

The American College of Cardiology and European Society of Cardiology guidelines indicate that an EF of 49% in a patient with mitral regurgitation represents early myocardial dysfunction, as the load-dependent measure masks the true contractile impairment, with a recommended LVEF of >64% in severe MR 3, 4
The American Heart Association recommends surgery for asymptomatic patients with chronic severe primary MR when LVEF is 30-60% and/or LVESD ≥40 mm (Stage C2), with a strength of evidence level I 1, 2

The American College of Cardiology recommends mitral valve surgery for asymptomatic patients with chronic severe primary MR and LV dysfunction (LVEF 30% to 60%), with a strength of evidence level I 1, 2
The European Society of Cardiology recommends mitral valve repair over replacement when surgical treatment is indicated, particularly for posterior leaflet pathology with detached chords, with a success rate of >90% in experienced centers 1, 2

The European Heart Journal suggests that degenerative MR with detached chordae can usually be successfully repaired using resection and annuloplasty techniques, with a success rate of >90% in experienced centers 5, 1

The European Society of Cardiology recommends oral anticoagulation (warfarin) for the first 3 months in all patients with mitral valve repair involving a prosthetic annuloplasty ring, with a target INR of 2.0-3.0 6
The European Heart Journal recommends lifelong anticoagulation with warfarin for all mechanical valves, with a target INR of 3.0 (range 2.5-3.5) 6, 7

The European Society of Cardiology recommends baseline echocardiography postoperatively and at completion of rehabilitation to permit comparison with future studies, with a multidisciplinary rehabilitation program available for all patients undergoing valve surgery 6

The European Heart Journal advises against delaying surgery waiting for symptoms to worsen or EF to decline further, as this results in irreversible LV dysfunction and worse outcomes, with a strength of evidence level II 5
The American College of Cardiology recommends ensuring surgery is performed at an experienced center with high repair success rates (>90%) for degenerative disease, with a strength of evidence level I 1, 2