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Table 17. Primary MR Intervention
Recommendations COR LOE
Mitral valve surgery is recommended for symptomatic
patients with chronic severe primary MR (stage D) and
LVEF >30%.
I B
Mitral valve surgery is recommended for asymptomatic
patients with chronic severe primary MR and LV dysfunction
(LVEF 30%–60% and/or le ventricular end-systolic diameter
[LVESD] ≥40 mm, stage C2).
I B
Mitral valve repair is recommended in preference to mitral
valve replacement (MVR) when surgical treatment is indicated
for patients with chronic severe primary MR limited to the
posterior leaflet.
I B
Mitral valve repair is recommended in preference to MVR
when surgical treatment is indicated for patients with
chronic severe primary MR involving the anterior leaflet
or both leaflets when a successful and durable repair can be
accomplished.
I B
Concomitant mitral valve repair or MVR is indicated in
patients with chronic severe primary MR undergoing cardiac
surgery for other indications.
I B
Mitral valve repair is reasonable in asymptomatic patients with
chronic severe primary MR (stage C1) with preserved LV
function (LVEF >60% and LVESD <40 mm) in whom the
likelihood of a successful and durable repair without residual
MR is >95% with an expected mortality rate of <1% when
performed at a Heart Valve Center of Excellence.
IIa B
Mitral valve surgery is reasonable for asymptomatic patients
with chronic severe primary MR (stage C1) and preserved
LV function (LVEF >60% and LVESD <40 mm) with a
progressive increase in LV size or decrease in ejection fraction
(EF) on serial imaging studies. (Figure 2)
(New recommendation for 2017)
IIa C-LD
Mitral valve repair is reasonable for asymptomatic patients
with chronic severe nonrheumatic primary MR (stage C1)
and preserved LV function (LVEF >60% and LVESD <40
mm) in whom there is a high likelihood of a successful
and durable repair with 1) new onset of AF or 2) resting
pulmonary hypertension (pulmonary artery systolic arterial
pressure >50 mm Hg ).
IIa B
Chronic Primary MR
Mitral Regurgitation
