Insuffisance mitrale et chirurgie conservatrice

Management of mitral regurgitation have benefited over the last 10 years from the better understanding of its natural history and from the advent of new echocardiographic quantitative methods. The dismal prognosis displayed by patients with flail leaflet and severe mitral regurgitation medically treated in one hand and the demonstration of the dramatic consequences of impaired pre-operative left ventricular function in the other, have been a strong incentive for early surgical correction of the disease. In the same time, mitral valve repair developed because of the improvement in the surgical techniques, of changes in aetiology and because of the widespread use of intra-operative transoesophageal echocardiography. Mitral repair has been shown to be an independent and beneficial predictor of overall survival, operative mortality and late survival and consequently became the support of early surgical strategies. But it is not the only factor to predict mortality and morbidity, and one must not forget the decisive and independent part played by age, preoperative symptoms and above all pre-operative left ventricular function. Therefore, mitral valve repair must not be considered as a pretext to postpone intervention but should be an other reason to intervene earlier.