Should a Cardiac Surgeon Blame Himself for Replacing a Mitral Valve?

and learned a lot about the importance of repair for mitral valve. Besides, we have attended a lot of meetings describing several repair techniques for different pathologies. Both European and American guidelines offer mitral valve repair whenever it is possible and they even do not suggest surgery under some circumstances if the likelihood of successful repair is not more than 95%. Papers from Europe and United States declare up to 70% repair rate for mitral valve and the trend is increasing each year. Is it the case for us? As junior cardiac surgeons, we feel sorry for each valve we replace in our centre. That’s why we checked our databases to answer the question, “what are we doing to the mitral valve?” The result was far beyond the results of developed countries. We repaired 28% of mitral valves in 2014. This was almost 50% more than the year 2012 as we repaired only 20% of mitral valves but still too low. Low for whom? Developed countries... In a speech during the 28 European Association for CardioThoracic Surgery Annual Meeting, Maldonado reported the rate of mitral repair in Latin America, and the results were almost the same as ours. Surgeons in Colombia, Chile, Mexico and Brazil repaired 30%, 32%, 39% and 42% of mitral valves, respectively, during 2013. What does this mean? Developing surgeons! Don’t they know how to repair mitral valves in developing countries? It shouldn’t be the case as each of the above countries has worldwide known and experienced surgeons, for example, the Brazilian Cardiac Surgery Society has more than 1200 surgeons performing around 70 thousand cardiac operations every year. Etiology of mitral valve disease is the most probable answer for the difference between developing and developed countries. Degenerative mitral valve regurgitation is the most suitable target for repair. Euro Heart Survey revealed that 72% of mitral valve diseases were pure mitral regurgitation and the majority (61%) of etiology was degenerative disease of the valve. On the other hand, the Turkish registry of heart valve disease showed that only 30% of pure mitral regurgitation was due to EDITORIAL