title: The cardiologist's role in increasing the rate of mitral valve repair in degenerative disease.
abstract: OBJECTIVE
  To highlight the relevance of preoperative differentiation of degenerative mitral valve disease based on etiology (predominantly Barlow's Disease or fibroelastic deficiency) and severity of lesions with an emphasis on how such differentiation by the cardiologist can result in increased rate of mitral valve repair.
  
  
  RESULTS
  In the hands of reference mitral valve-repair surgeons, 95-100% of degenerative valves are repairable, regardless of etiology; however, in the general cardiac surgical community, the repair rates are around 50%. In contrast to fibroelastic deficiency, Barlow's valves have more complex pathology and require advanced techniques to effect a repair. We present a simple algorithm that enables the cardiologist to stratify degenerative mitral valves into those that are repairable by any experienced cardiac surgeon and those that require reference-center referral to deliver a high probability of repair. Such targeted referral strategy should result in near 100% repair rate for degenerative disease.
  
  
  CONCLUSIONS
  Essentially, all degenerative mitral valves are repairable. By matching echocardiographic findings to the appropriate surgical skill level required to consistently deliver a repair, valve replacement for degenerative mitral valve disease should be infrequent.
authors.affiliation: Department of Cardiothoracic Surgery and The Mount Sinai Medical Center, New York, New York 10029, USA. david.adams@mountsinai.org
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
authors.forename: Anelechi C
authors.initials: AC
authors.lastname: Anyanwu
mesh_terms: D002309:Cardiology; D006349:Heart Valve Diseases / Q000601:surgery; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D010819:Physician's Role