MR Surgical Indications

Associate Editor-In-Chief:

Indications for surgery for chronic mitral regurgitation include signs of left ventricular dysfunction.

These include an ejection fraction of less than 60 percent and a left ventricular end systolic dimension (LVESD) of greater than 45 mm.

Factors influencing the timing of surgery for MR include symptoms, LV EF, LV end-systolic dimension, atrial fibrillation, and pulmonary hypertension. In most situations, MV repair is the operation of choice for those patients with suitable MV anatomy. Operation is indicated for most patients with severe MR and any symptoms. Operation is also indicated in asymptomatic patients who demonstrate mild to moderate LV dysfunction (EF 0.30 to 0.60 and end-systolic dimension 40 to 55 mm). The patient with severe LV dysfunction (EF less than 0.30 and/or end-systolic dimension greater than 55 mm) poses a higher risk but may undergo surgery if chordal preservation is likely. There is controversy regarding the timing of surgery in the asymptomatic patient with severe MR and normal LV function. If MV repair can be performed with a high degree of success and the operative risk is low, it is reasonable to proceed with surgery to prevent irreversible LV dysfunction from occurring. However, this “early” operation should only be performed at centers in which there is a high likelihood of successful MV repair because of their demonstrated expertise in this area.