This protocol applies to patients with mitral valve prolapse presenting with severe primary mitral regurgitation classified as Stage C2 — those who remain asymptomatic yet show signs of evolving ventricular compromise.
The defining feature of this sub-population is the presence of LV systolic dysfunction: a left ventricular ejection fraction of 60% or less, or a left ventricular end-systolic dimension of 40 mm or greater. Despite the absence of symptoms, this degree of ventricular remodelling marks a critical threshold in severe primary mitral regurgitation.
A surgical intervention targeting the mitral valve is the recommended course of action at this stage. When the underlying anatomic cause is degenerative disease, a specific type of valve-preserving procedure is preferred over valve replacement — provided a durable result is achievable.
Full procedural details, decision criteria, and sequencing are in the complete protocol →DOI: 10.1161/CIR.0000000000000923
In asymptomatic patients with severe primary MR and LV systolic dysfunction (LVEF ≤60%, LVESD ≥40 mm) (Stage C2), mitral valve surgery is recommended.
In patients with severe primary MR for whom surgery is indicated, mitral valve repair is recommended in preference to mitral valve replacement when the anatomic cause of MR is degenerative disease, if a successful and durable repair is possible.
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