Management Strategy for Intervention for Primary Mitral Regurgitation

Management Strategy for Intervention for Primary Mitral Regurgitation

Management Strategy for Intervention for Primary Mitral Regurgitation Mitral Regurgitation Mitral Regurgitation

«Flowchart»

Primary mitral regurgitation

Primary mitral regurgitation

Primary mitral regurgitation

Primary mitral regurgitation

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Severe MR (VC ≥0.7cm,
RVol ≥60ml, RF ≥50%,
ERO ≥0.40 cm ² )

Severe MR (VC ≥0.7cm,
RVol ≥60ml, RF ≥50%,
ERO ≥0.40 cm ² )

Severe MR (VC ≥0.7cm,
RVol ≥60ml, RF ≥50%,
ERO ≥0.40 cm ² )

≥
≥ ≥
≥ ²

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MV surgery (1)

MV surgery (1)

MV surgery (1)

LV systolic dysfunction (Stage C2)
(LVEF ≤60% or ESD ≥40 mm)

LV systolic dysfunction (Stage C2)
(LVEF ≤60% or ESD ≥40 mm)

≤ ≥ LV systolic

Normal LV systolic function (Stage C1)
(LVEF >60% or ESD <40mm)

Normal LV systolic function (Stage C1)
(LVEF >60% or ESD <40mm)

Normal LV

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Transcatheter edge-to-edge MV repair (2a)

Transcatheter edge-to-edge MV repair (2a)

Transcatheter edge-to-edge MV repair (2a)

Successful and durable repair possible

Successful and durable repair possible

Successful and durable repair possible

Successful and durable repair possible

Successful and durable repair possible

Successful and durable repair possible

High or prohibitive
surgical risk with
anatomy favorable
for transcatheter
approach and life
expectancy >1y

High or prohibitive
surgical risk with
anatomy favorable
for transcatheter
approach and life
expectancy >1y

High or prohibitive

Degenerative MV disease

Degenerative MV disease

Degenerative MV disease

Rheumatic MV disease

Rheumatic MV disease

Rheumatic MV disease

MV surgery at primary or CVC (1)

MV surgery at primary or CVC (1)

MV surgery at primary or CVC (1)

MV repair at CVC (2b)

MV repair at CVC (2b)

MV repair at CVC (2b)

Symptoms due to
MR (stage D)
(regardless of LV function)

Symptoms due to
MR (stage D)
(regardless of LV function)

Symptoms

No symptoms due to
MR (stage C)

No symptoms due to
MR (stage C)

No symptoms

MV repair or replacement (2b)

MV repair or replacement (2b)

MV repair or replacement (2b)

Expected surgical mortality
<1% with >95% likelihood
of successful and durable
repair without residual MR

Expected surgical mortality
<1% with >95% likelihood
of successful and durable
repair without residual MR

Expected surgical mortality

Progressive increase in LV
size or decrease in LVEF
on at least 3 studies

Progressive increase in LV
size or decrease in LVEF
on at least 3 studies

Progressive

Progressive increase in LV
ize or decrease in LVEF
on at least 3 studies

Progressive increase in LV
ize or decrease in LVEF
on at least 3 studies

Progressive increase in LV
ize or decrease in LVEF
on at least 3 studies

MV repair at primary or CVC (2a)

MV repair at primary or CVC (2a)

MV repair at primary or CVC (2a)

No

No

No

Yes

Yes

Yes

MV repair or replacement (2b)

MV repair or replacement (2b)

MV repair or replacement (2b)