Evolution of Surgical Techniques for Mitral Valve Repair

In the Western World, most surgery on the mitral valve nowadays is performed for insufficiency secondary to degenerative disease, rather than for the rheumatic lesions seen so widely in the past. The advantages of mitral valve repair over prosthetic replacement for degenerative mitral insufficiency are well established, including lower early and late mortality rates, superior preservation of left ventricular function, and greater freedom from thromboembolism, anticoagulant-related complications, and endocarditis. It has been acknowledged that, in dedicated centers, mitral valve repair for these lesions is feasible in about 95% of cases.(1) In the United States, a recent survey performed by the Society of Thoracic Surgeons shows that the rate of valve repair versus replacement has gradually increased over decades, and now approximates 70%.(2)