A2 Refereed review article in a scientific journal
Asymptomatic severe degenerative mitral regurgitation
Authors: Björn, Rikhard; Strom, Jordan B.; Lloyd, Guy; Bhattacharyya, Sanjeev
Publisher: BMJ PUBLISHING GROUP
Publishing place: LONDON
Publication year: 2025
Journal: Heart
Journal name in source: HEART
Journal acronym: HEART
Volume: 111
Issue: 2
First page : 47
Last page: 54
Number of pages: 8
ISSN: 1355-6037
eISSN: 1468-201X
DOI: https://doi.org/10.1136/heartjnl-2024-324739
Web address : https://heart.bmj.com/content/111/2/47
Abstract
Degenerative mitral valve disease is common. Up to a quarter of patients with degenerative mitral valve disease may be asymptomatic despite having severe valve regurgitation. Current guideline indications for intervention in asymptomatic patient are centred on left ventricular dimensions and ejection fraction and may include consideration in atrial fibrillation, pulmonary hypertension and those with left atrial dilatation. However, despite intervention according to these recommendations, patients remain at risk of post-operative heart failure and mortality. Newer risk markers have been developed including left ventricular and atrial strain, myocardial fibrosis demonstrated using late gadolinium enhancement, mitral annular disjunction and ventricular arrhythmia burden. Translating newer markers into clinical practice will require integrating and identifying high-risk phenotypes that benefit from early intervention using machine learning techniques and artificial intelligence. Valve repair is the recommended intervention. However, repair rate and durability are dependent on both operator and centre volumes as well as valve characteristics. Recent advancements, including robotic surgery, may enhance repair rates; however, larger datasets are necessary to confirm these improvements. Efforts should focus on establishing high-volume regional centres of excellence for mitral valve repair.
Degenerative mitral valve disease is common. Up to a quarter of patients with degenerative mitral valve disease may be asymptomatic despite having severe valve regurgitation. Current guideline indications for intervention in asymptomatic patient are centred on left ventricular dimensions and ejection fraction and may include consideration in atrial fibrillation, pulmonary hypertension and those with left atrial dilatation. However, despite intervention according to these recommendations, patients remain at risk of post-operative heart failure and mortality. Newer risk markers have been developed including left ventricular and atrial strain, myocardial fibrosis demonstrated using late gadolinium enhancement, mitral annular disjunction and ventricular arrhythmia burden. Translating newer markers into clinical practice will require integrating and identifying high-risk phenotypes that benefit from early intervention using machine learning techniques and artificial intelligence. Valve repair is the recommended intervention. However, repair rate and durability are dependent on both operator and centre volumes as well as valve characteristics. Recent advancements, including robotic surgery, may enhance repair rates; however, larger datasets are necessary to confirm these improvements. Efforts should focus on establishing high-volume regional centres of excellence for mitral valve repair.
Funding information in the publication:
The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
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