Mitral valve replacement in young patients: review and current challenges
Creators: name: Hage, Fadi
name: Hage, Ali
name: Cervetti, Manuel R
name: Chu, Michael W. A.
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Genetics
subject: FOS: Biological sciences
subject: Physiology
subject: Biotechnology
subject: Ecology
subject: Immunology
subject: FOS: Clinical medicine
subject: Biological Sciences not elsewhere classified
subject: Marine Biology
subject: Science Policy

description: Mitral valve repair is the ideal intervention for mitral valve disease with excellent long-term survival comparable to the age-matched general population. When the mitral valve is not repairable, mechanical prostheses may be associated with improved survival as compared with biological prostheses. Newer mechanical and biological valve prostheses have the potential to improve outcomes following mitral valve replacement in young patients. Patients presenting for mitral valve surgery after failed transcatheter mitral valve-in-valve have high rates of postoperative mortality and morbidity, exceeding those seen with reoperative mitral valve surgery, which poses issues in young patients who have a higher cumulative incidence of reintervention. Patients presenting with mitral valve disease, the most common type of heart valve disease, have a survival advantage when they undergo mitral valve repair as opposed to replacement, and this is particularly true for young patients. When the mitral valve is not repairable, mechanical prostheses (prosthetic implants) may be associated with improved survival as compared with biological prostheses, and this difference is mostly observed until the age of 70 years. Newer techniques of treating mitral valve disease without requiring open heart surgery have not yet been shown to be superior or even equivalent to traditional open heart surgery in the general population. Patients presenting for mitral valve surgery after failure of these newer techniques have high rates of death, exceeding those seen with mitral valve reoperation, which has important implications for young patients with mitral valve disease. Patients presenting with mitral valve disease have a survival advantage when they undergo mitral valve repair as opposed to replacement, and this is particularly true for young patients. Most young patients with degenerative mitral disease can be successfully repaired but those with nondegenerative etiology pose a greater challenge, including patients with infective endocarditis and advanced rheumatic disease. When the mitral valve is not repairable, mechanical prostheses may be associated with improved survival as compared with biological prostheses, and this difference in survival is mostly observed until the age of 70 years. Newer mechanical and biological valve prostheses have the potential to improve outcomes following mitral valve replacement in young patients. As compared with primary mitral valve surgery, reoperation is associated with significantly higher mortality and morbidity. Patients presenting for redo mitral surgery might benefit from a right mini-thoracotomy approach as opposed to a median resternotomy. While transcatheter mitral valve-in-valve is a less invasive and appealing option, there are multiple concerns about exponentially increasing transvalvular gradients with each subsequent valve-in-valve, which may limit its durability and success in young patients.