This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Di Salvo, T. G. Articles by Byrne, J. G. Search for Related Content PubMed PubMed Citation Articles by Di Salvo, T. G. Articles by Byrne, J. G. Related Collections Related Article

QUARTERLY FOCUS ISSUE: HEART FAILURE: STATE-OF-THE-ART PAPER

Mitral Valve Surgery in Advanced Heart Failure

Thomas G. Di Salvo, MD, MPH, MBA^_*,_*, Michael A. Acker, MD, G. William Dec, MD and John G. Byrne, MD^_*

^_* Vanderbilt University, Nashville, Tennessee
University of Pennsylvania, Philadelphia, Pennsylvania
Massachusetts General Hospital, Boston, Massachusetts

Manuscript received February 27, 2009; revised manuscript received August 7, 2009, accepted August 10, 2009.

^_* Reprint requests and correspondence: Dr. Thomas G. Di Salvo, Vanderbilt Heart and Vascular Institute, 1215 21st Avenue, MCE 5th Floor, Suite 5037, Nashville, Tennessee 37232 (Email: thomas.g.disalvo{at}vanderbilt.edu).

The appropriateness and timing of mitral valve surgery in patients with advanced heart failure and severe mitral regurgitation remains controversial. Recent surgical results provide evidence for beneficial effects on left ventricular remodeling and functional capacity. Given the absence of randomized trials comparing the outcomes of mitral valve surgery to medical therapy, however, clinical decision making regarding surgery for these fragile patients poses a dilemma to thoughtful clinicians. This paper reviews the pathophysiology of mitral regurgitation in heart failure and proposes an integrated approach to management.

Key Words: mitral regurgitation • heart failure • cardiac surgery

Abbreviations and Acronyms   CABG = coronary artery bypass graft surgery   CRT = cardiac resynchronization therapy   HF = heart failure   LV = left ventricular   LVEDD = left ventricular end-diastolic diameter   LVEF = left ventricular ejection fraction   MR = mitral regurgitation   MRI = magnetic resonance imaging   MV = mitral valve   MVA = mitral valve annuloplasty   MVR = mitral valve repair   NHBLI = National Heart, Lung, and Blood Institute   NYHA = New York Heart Association

Related Article

Inside This Issue
J. Am. Coll. Cardiol. 2010 55: A35-A33. [Full Text] [PDF]