Current status of mitral valve repair.

Mitral valve repair is the procedure of choice to treat mitral valve dysfunction. Advantages of mitral valve repair over mitral valve replacement include improved long-term survival, better preservation of left ventricular function, and greater freedom from endocarditis, thromboembolism, and anticoagulant-related hemorrhage. The feasibility and durability of mitral valve repair depend upon the etiology of mitral valve dysfunction. In degenerative and ischemic mitral valve diseases, valve repair is possible in 90% of cases and freedom from reoperation is high. In contrast, rheumatic valves are less amenable to repair and durability is limited. Most isolated valve operations can be performed in a minimally invasive fashion using a partial upper sternotomy. In patients with atrial fibrillation and mitral valve disease, the Maze procedure or pulmonary vein isolation is performed, eliminating atrial fibrillation and the need for long-term anticoagulation.