Figure 1. Indications for Surgery for MR
MR
Primary MR Secondary MR
Severe MR
• Vena contracta ≥0.7 cm
• RVol ≥60 mL
• RF ≥50%
• ERO ≥0.4 cm
2
• LV dilation
Progressive MR
(stage B)
• Vena contracta <0.7 cm
• RVol <60 mL
• RF <50%
• ERO <0.4 cm
2
• CAD Rx
• HF Rx
• Consider CRT
Symptomatic
(stage D)
Asymptomatic
(stage C)
LVEF
30%-≤60% or
LVESD ≥40 mm
(stage C2)
LVEF >60% and
LVESD <40 mm
(stage C1)
New onset
AF or PASP
>50 mm Hg
(stage C1)
Likelihood of successful
repair >95% and
Expected mortality <1%
Periodic
Monitoring
MV Repair
(IIa)
MV
Surgery
a
(I)
NO YES
MV
Surgery
a
(IIb)
LVEF >30%
NO
YES
Symptomatic
severe MR
(stage D)
Asymptomatic
severe MR
(stage C)
Progressive
MR
(stage B)
MV
Surgery
a
(IIb)
Periodic
Monitoring
Persistent
NYHA
class III-IV
symptoms
a
MV repair is preferred over MVR when possible.
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