title: Degenerative mitral valve regurgitation: best practice revolution.
abstract: Degenerative mitral valve disease often leads to leaflet prolapse due to chordal elongation or rupture, and resulting in mitral valve regurgitation. Guideline referral for surgical intervention centres primarily on symptoms and ventricular dysfunction. The recommended treatment for degenerative mitral valve disease is mitral valve reconstruction, as opposed to valve replacement with a bioprosthetic or mechanical valve, because valve repair is associated with improved event free survival. Recent studies have documented a significant number of patients are not referred in a timely fashion according to established guidelines, and when they are subjected to surgery, an alarming number of patients continue to undergo mitral valve replacement. The debate around appropriate timing of intervention for asymptomatic severe mitral valve regurgitation has put additional emphasis on targeted surgeon referral and the need to ensure a very high rate of mitral valve repair, particularly in the non-elderly population. Current clinical practice remains suboptimal for many patients, and this review explores the need for a 'best practice revolution' in the field of degenerative mitral valve regurgitation.
authors.affiliation: Department of Cardiothoracic Surgery, The Mount Sinai School of Medicine, 1190 Fifth Avenue, New York, NY 10029, USA. david.adams@mountsinai.org
authors.forename: David H
authors.initials: DH
authors.lastname: Adams
authors.forename: Raphael
authors.initials: R
authors.lastname: Rosenhek
authors.forename: Volkmar
authors.initials: V
authors.lastname: Falk
mesh_terms: D004453:Echoencephalography; D004695:Endocardial Fibroelastosis / Q000150:complications; D040181:Genetic Diseases, X-Linked / Q000150:complications; D019983:Guideline Adherence; D006801:Humans; D058386:Mitral Valve Annuloplasty / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D008945:Mitral Valve Prolapse / Q000150:complications; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000601:surgery