Mitral Valve Surgery

Question 1

NIH Trial on MVRepair vs. MVR for severe Ischemic MR - Primary endpoint

Answer 1

LVESVI at 12months

(Acker MA - NEJM 2014)

Question 2

NIH Trial CABG vs. CABG+MVRepair for Ischemic MR - Percentage of moderate or severe MR at 1yr

Answer 2

30% CABG alone

10% CABG+MVRepair

(Smith PK - NEJM 2014)

Question 3

Wilkins Score

Answer 3

Feasibility for balloon valvuloplasty for MS

Feasible < 8 - 9 > Not Feasible

Determinants:

1. Leaflet Mobility
2. Leaflet Thickening
3. Leaflet Calcification
4. Subvalvular Thickening

Question 4

SAM - Medical Treatment

Answer 4

1. Beta-blockers
2. Increase Volume/Preload
3. Increase Afterload
4. Decrease Inotropes/Contractility
5. AV Synchrony/Pacing

Question 5

COAPT Trial - Primary effectiveness endpoint

Answer 5

All hospitalizations for CHF in 24-months

35% per-patient-year Device Group

65% per-patient-year Control Group

Question 6

COAPT Trial - Death from any cause rate

Answer 6

In 24months

30% Device Group

45% Control Group

*Statistically significant

Question 7

MitraFR Trial - Primary endpoint

Answer 7

Composite at 12-months

1. Death from any cause
2. Unplanned hospitalization for CHF

55% Device Group

50% Control Group

NOT statistically significant

Question 8

MitraFR Trial - Common criticisms

Answer 8

Definition of severe MR

ROA > 20mm² (AHA Guidelines > 40mm2)

Regurg Volume > 30mL/beat (AHA Guidelines > 60mL/beat)

Question 9

Mechanisms of posteriorly directed MR

Answer 9

1. Prolapse of the anterior mitral leaflet
2. Restriction of the posterior mitral leaflet