AM Report Pearls: Indications for Mitral Valve Replacement
- ACC/AHA Guidelines from 2014 recommend mitral valve surgery [Class I indication] if patients are symptomatic and LVEF > 30%
- HOWEVER, Yerem cautioned us that in MR, a “normal” EF can be falsely reassuring because the regurgitant fraction can fool you!
- He recommends that patients with symptomatic MR with EF < 60% should be evaluated for MVR! (and LV end-systolic diameter > 40 mm – easy to remember 60/40)
- Other class I indications for mitral valve surgery:
- Again, any SYMPTOMATIC patients with LV dysfunction
- Asymptomatic patients with LV dysfunction (EF 30-60% and/or LV end-systolic diameter > 40mm)
- Mitral valve repair or MVR are indicated in patients undergoing other cardiac surgery!
- Class II indications for mitral valve surgery:
- Asymptomatic patients with preserved LV function (>60%) if expected surgical mortality < 1% at “Heart Valve Center of Excellence”
- Remember, these are all referring to PRIMARY mitral regurg, there are different guidelines for “functional” or secondary mitral regurgitation
- For full nitty-gritty, check out the updated ACC/AHA 2014 guidelines here: http://circ.ahajournals.org/content/early/2014/02/27/CIR.0000000000000029
Bonus Pearl: NOACs and Cancer Patients
- We discussed how the novel oral anticoagulants are currently only approved for NON-VALVULAR atrial fibrillation and are not approved for VALVULAR atrial fibrillation
- Here is the article in CHEST I mentioned – a review of NOACs in cancer patients: http://journal.publications.chestnet.org/article.aspx?articleid=1905082