Table 9. Intervention in Patients With Chronic Primary MR
Recommendations COR LOE
MV surgery is recommended for symptomatic patients with
chronic severe primary MR (stage D) and LVEF >30%.
I B
MV surgery is recommended for asymptomatic patients
with chronic severe primary MR and LV dysfunction (LVEF
30%-60% and/or LVESD ≥40 mm, stage C2).
I B
MV repair is recommended in preference to MVR when
surgical treatment is indicated for patients with chronic
severe primary MR limited to the posterior leaflet.
I B
MV 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 MV repair or MVR is indicated in patients
with chronic severe primary MR undergoing cardiac surgery
for other indications.
I B
MV 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
MV 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 PHTN (PA
systolic arterial pressure >50 mm Hg ).
IIa B
Concomitant MV repair is reasonable in patients with
chronic moderate primary MR (stage B) undergoing cardiac
surgery for other indications.
IIa C
MV surgery may be considered in symptomatic patients with
chronic severe primary MR and LVEF ≤30% (stage D).
IIb C
MV repair may be considered in patients with rheumatic
MV disease when surgical treatment is indicated if a durable
and successful repair is likely or if the reliability of long-term
anticoagulation management is questionable.
IIb B
Transcatheter MV repair may be considered for severely
symptomatic patients (NYHA class III-IV) with chronic
severe primary MR (stage D) who have favorable anatomy
for the repair procedure and a reasonable life expectancy
but who have a prohibitive surgical risk because of severe
comorbidities and remain severely symptomatic despite
optimal GDMT for HF.
IIb B
MVR should NOT be performed for treatment of isolated
severe primary MR limited to less than one half of the
posterior leaflet unless MV repair has been attempted and
was unsuccessful.
III: Harm B
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