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Controversies in valvular heart surgery

Session presentations
  • Mitral valve annuloplasty in ischaemic mitral regurgitation. Presented by Jean-Francois AVIERINOS (Marseille, FR)See the slides
  • Patient-prosthesis mismatch. Presented by Julien MAGNE (Liege, BE)See the slides
  • When and how to treat. Presented by Michael A BORGER (Leipzig, DE)See the slides
  • Mitral repair in asymptomatic patients. Presented by Michele DE BONIS (Milano, IT)
Cardiovascular Surgery


The session started with Jean-Francois Avierinos who first explored the pathophysiology of secondary mitral insufficiency.
He explained the different mechanisms leading to secondary MI and discussed the indication for repair versus replacement based on the extent of subvalvular involvement.

Patient prosthesis mismatch continues to be a matter of lively debates. In his elegant talk Julien Magne gave a definition of PPM and discussed the implication for both aortic and mitral valve replacement. Severe PPM has an impact on survival and should be avoided whenever feasible.

Michael Borger gave an overview about various mitral valve repair techniques for degenerative mitral valve insufficiency with special focus on the results with the Loop-technique. He also demonstrated different repair techniques for Barlows disease and discussed the contemporary outcomes of mitral valve repair. In high volume centers mortality is less than 1% and repair rates exceed 90%. Long term freedom from reoperation or >II+ MI after 10 years is currently in the range of >90% independent of the underlying pathology (posterior, anterior or bileaflet prolapse).

The timing for mitral valve repair in asymptomatic patients is a matter of continuing debate. The so called “watchful waiting” strategy is favoured by some whereas early surgery is preferred by others. Michele De Bonis from Milan presented the evidence that led to the current guideline recommendations for mitral valve repair in degenerative disease, that gives indications also for patients with asymptomatic severe MI. In addition he presented evidence for other subtle changes such as an increase in left atrial dimension that may have a negative prognostic impact in patients left untreated. Early intervention for asymptomatic patients especially is however only justifiable if excellent operative results can be accomplished.

References


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Controversies in valvular heart surgery

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.