Timing of surgery for mitral valve regurgitation

One of the most notable areas of controversy in treating chronic mitral valve regurgitation (MR) is when to have surgery. Chronic MR progresses slowly and certainly, and you want to either repair or replace your valve before volume overload and increased pumping pressure do permanent damage to your heart. On the other hand, surgery to correct MR is a major procedure that has its own risks and complications. In addition, the artificial valves used during valve replacements deteriorate over time, so you may need additional surgeries in your life if you replace your valve. This should be taken into account when deciding on the timing of surgery.

The first disagreement centers on whether or not you should wait until symptoms appear before having surgery. Although it may seem logical to repair or replace your valve only when you begin to feel that something is wrong, MR may have damaged your heart permanently by the time symptoms present themselves. Many clinical studies have been performed to evaluate this issue, and most doctors have come to accept the general need to replace the valve before symptoms are evident.

But this may be balanced by factors such as advanced age and overall health. For example, the older you are or the more compromised other body functions may be, the riskier the prospect of open-heart surgery. You and your doctor should discuss your specific circumstances when deciding on the timing of valve repair or replacement.

The second disagreement centers on when you should have surgery. The severity of your mitral regurgitation is measured by two main criteria: the percentage of blood leaving your left ventricle with each pump (ejection fraction) and the size of your left ventricle at rest. Valve repair or replacement is generally recommended when your ejection fraction drops to less than 60% and/or when your left ventricle is dilated to 40 mm at rest (diastole).1 This should be balanced against information about your individual condition and overall health.

Citations

  1. Bonow RO, et al. (2006) ACC/AHA 2006 guidelines for the management of patients with valvular heart disease. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients with Valvular Heart Disease). Circulation, 114(5): e84–e231.

Last Updated: February 12, 2010

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