When to Operate on a Mitral Valve? Plus Bonus Pearl on NOACs

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

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