Mitral valve surgery for rheumatic heart disease: replace, repair, retrain?

Abstract:

PURPOSE OF REVIEW:Rheumatic heart disease (RHD) affects over 30 million people worldwide. Substantial variation exists in the surgical treatment of patients with RHD. Here, we aim to review the surgical techniques to treat RHD with a focus on rheumatic mitral valve (MV) repair. We introduce novel educational paradigms to embrace repair-oriented techniques in cardiac centers. RECENT FINDINGS:Due to the low prevalence of RHD in high-income countries, limited expertise in MV surgery for RHD, technical complexity of MV repair for RHD and concerns about durability, most surgeons elect for MV replacement. However, in some series, MV repair is associated with improved outcomes, fewer reinterventions, and avoidance of anticoagulation-related complications. In low- and middle-income countries, the RHD burden is large and MV repair is more commonly performed due to high rates of loss-to-follow-up and barriers associated with anticoagulation, international normalized ratio monitoring, and risk of reintervention. SUMMARY:Increased consideration for MV repair in the setting of RHD may be warranted, particularly in low- and middle-income countries. We suggest some avenues for increased exposure and training in rheumatic valve surgery through international bilateral partnership models in endemic regions, visiting surgeons from endemic regions, simulation training, and courses by professional societies.

journal_name

Curr Opin Cardiol

authors

Vervoort D,Ouzounian M,Yanagawa B

doi

10.1097/HCO.0000000000000826

subject

Has Abstract

pub_date

2020-12-24 00:00:00

eissn

0268-4705

issn

1531-7080

pii

00001573-900000000-98936

journal_volume

Publish Ahead of Print

pub_type

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