Mitral valve repair: an odyssey to save the valves!

The history of mitral valve repair surgery is an interesting odyssey that has nearly spanned the century. However, since the mid 1970s, both European and North American surgeons have developed and expanded these techniques to where repair of myxomatous valves is now expected by most cardiologists and patients. Preoperative functional assessment is most important to determine the specific needs for repair. Today, transesophageal echocardiography is the standard by which cardiologists and surgeons rely for these data. Herein, both methods of assessment and techniques for repair are detailed. The multidisciplinary approach is emphasized. Risks of surgery are detailed as well as long-term outcomes compared with replacement of the mitral valve. Lastly, surgical results from the 235 patients repair series at the East Carolina University School of Medicine are detailed and discussed. This series showed a 1.8% mortality rate for myxomatous valve patients, with a very low reoperative rate. This compared with a higher mortality rate of 5.6% for the overall group, which emphasizes the increased risk associated with an ischemic etiology. The author provides not only an overview but also tips to surgeons beginning to repair valves.