Surgical treatment

Primary mitral regurgitation

• offer surgical mitral valve repair (by median sternotomy or minimally invasive surgery) to adults with severe* primary mitral regurgitation and an indication for repair, if surgery is suitable
• offer surgical mitral valve replacement (by median sternotomy or minimally invasive surgery) to adults with severe* primary mitral regurgitation and an indication for surgery, if the valve is not suitable for repair and surgery is suitable
• consider transcatheter edge-to-edge repair, if suitable, for adults with severe* primary mitral regurgitation and symptoms, if surgery is unsuitable

Secondary mitral regurgitation

• consider surgical mitral valve repair (by median sternotomy or minimally invasive surgery) for adults with severe* secondary mitral regurgitation who are having cardiac surgery for another indication, if surgery is suitable
• consider surgical mitral valve replacement (by median sternotomy or minimally invasive surgery) for adults with severe* secondary mitral regurgitation who are having cardiac surgery for another indication, if the valve is not suitable for repair and surgery is suitable
• offer medical management to adults with heart failure and severe* secondary mitral regurgitation, if surgery is unsuitable
• consider transcatheter mitral edge-to-edge repair for adults with heart failure and severe* secondary mitral regurgitation, if surgery is unsuitable and they remain symptomatic on medical management

* severity of valve disease is defined in line with the British Society of Echocardiography guidelines on the British Heart Foundation's website

Reference:

• NICE (November 2021). Heart valve disease presenting in adults: investigation and management