ANESTHESIOLOGISTS cannot concentrate solely on advances made within the specialty, but must also keep up with developments occurring within the field of surgery because the surgical management of the patients partly determines the anesthetic management. Mitral valve disease and its surgical therapy represent a very dynamic area within the field of cardiac surgery. Thanks to better understanding of the anatomy of the mitral valve apparatus, pathophysiology of underlying disease processes, and improvements in surgical technique, a shift has taken place clearly favoring mitral valve repair over mitral valve replacement for regurgitant lesions.
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A comparison of repair and replacement for mitral valve incompetence.
J Thorac Cardiovasc Surg. 1987; 94: 208-219
2Despite this shift in surgical philosophy, as reflected in the 2006 guidelines published by the American Heart Association/American College of Cardiology (AHA/ACC), repair rates for mitral valve regurgitation continue to languish around 50% in the United States and Europe,
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Mitral valvuloplasty is superior to valve replacement for preservation of left ventricular function; an intraoperative two-dimensional echocardiographic study.
J Am Coll Cardiol. 1987; 10: 568-575
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- DiSesa V.J.
Use of mitral valve repair: analysis of contemporary United States experience reported to the Society of Thoracic Surgeons National Cardiac Database.
Ann Thorac Surg. 2003; 75: 820-825
4even though numerous reports have shown that mitral valve repair is durable and has superior long-term survival rates when compared with mitral valve replacement.
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A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease.
Eur Heart J. 2003; 24: 1231-1243
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Similar long-term results of mitral valve repair for anterior compared with posterior leaflet prolapse.
J Thorac Cardiovasc Surg. 2006; 131: 364-370
- David T.E.
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- et al.
A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse.
J Thorac Cardiovasc Surg. 2005; 130: 1242-1249
- Gillinov A.M.
- Cosgrove D.M.
- Blackstone E.H.
- et al.
Durability of mitral valve repair for degenerative disease.
J Thorac Cardiovasc Surg. 1998; 116: 734-743
- Adams D.H.
- Anyanwu A.
- Rahmanian P.B.
- et al.
Larger annuloplasty rings facilitate mitral valve repair in Barlow's syndrome.
Ann Thorac Surg. 2006; 82: 2096-2100
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- A comparison of repair and replacement for mitral valve incompetence.J Thorac Cardiovasc Surg. 1987; 94: 208-219
- Mitral valvuloplasty is superior to valve replacement for preservation of left ventricular function; an intraoperative two-dimensional echocardiographic study.J Am Coll Cardiol. 1987; 10: 568-575
- Use of mitral valve repair: analysis of contemporary United States experience reported to the Society of Thoracic Surgeons National Cardiac Database.Ann Thorac Surg. 2003; 75: 820-825
- A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease.Eur Heart J. 2003; 24: 1231-1243
- Similar long-term results of mitral valve repair for anterior compared with posterior leaflet prolapse.J Thorac Cardiovasc Surg. 2006; 131: 364-370
- A comparison of outcomes of mitral valve repair for degenerative disease with posterior, anterior, and bileaflet prolapse.J Thorac Cardiovasc Surg. 2005; 130: 1242-1249
- Durability of mitral valve repair for degenerative disease.J Thorac Cardiovasc Surg. 1998; 116: 734-743
- Larger annuloplasty rings facilitate mitral valve repair in Barlow's syndrome.Ann Thorac Surg. 2006; 82: 2096-2100
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William C. Oliver, Jr, MD
Paul G. Barash, MD
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.