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Year in review: mitral valve surgery

Purpose of review In the past year, there has been progress on several fronts in the field of mitral valve surgery and intervention. Here, we review key publications regarding the surgical and transcatheter management of mitral valve disease. Recent findings This past year heralded the publication of the 2014 American Heart Association (AHA)/American College of Cardiology (ACC) Guidelines for the Management of Patients With Valvular Heart Disease. Regarding degenerative mitral regurgitation, low risk of operative mortality and data demonstrating clinical benefit for early surgery are prompting renewed calls for early intervention before guideline-based triggers. For functional mitral regurgitation, the precise roles of chordal-sparing replacement versus repair and the optimal management of moderate disease at the time of surgical revascularization are unclear. Sternal-sparing minimally invasive mitral valve surgery has become a mature procedure in experienced centers and offers comparable surgical morbidity and mortality with superior cosmesis and faster return to baseline function. Transcatheter interventions for mitral regurgitation continue to undergo development and testing. Mounting experience and ongoing clinical trials with the MitraClip endovascular edge-to-edge repair device will provide important data on the optimal target population for this device. Summary This past year has seen important advances in the surgical treatment of degenerative and functional mitral regurgitation as well as continued refinement of transcatheter interventions.