Recommendations | Class of recommendation | Level of evidence |
PMBC is recommended for symptomatic patients with severe MS (MVA ≤1.5 cm2, stage D) and favorable valve morphology in the absence of contraindications | I | A |
Mitral valve surgery is indicated in severely symptomatic patients (NYHA class III/IV) with severe MS (MVA ≤1.5 cm2, stage D) who are not high risk for surgery and who are not candidates for or failed previous PMBC | I | B |
Concomitant mitral valve surgery is indicated for patients with severe MS (MVA ≤1.5 cm2, stage C or D) undergoing other cardiac surgery | I | C |
PMBC is reasonable for asymptomatic patients with very severe MS (MVA ≤1.0 cm2, stage C) and favorable valve morphology in the absence of contraindications | IIa | C |
Mitral valve surgery is reasonable for severely symptomatic patients (NYHA class III/IV) with severe MS (MVA ≤1.5 cm2, stage D), provided there are other operative indications | IIa | C |
PMBC may be considered for asymptomatic patients with severe MS (MVA ≤1.5 cm2, stage C) and favorable valve morphology who have new onset of AF in the absence of contraindications | IIb | C |
PMBC may be considered for symptomatic patients with MVA >1.5 cm2 if there is evidence of hemodynamically significant MS during exercise | IIb | C |
PMBC may be considered for severely symptomatic patients (NYHA class III/IV) with severe MS (MVA ≤1.5 cm2, stage D) who have suboptimal valve anatomy and are not candidates for surgery or at high risk for surgery | IIb | C |
Concomitant mitral valve surgery may be considered for patients with moderate MS (MVA 1.6 to 2.0 cm2) undergoing other cardiac surgery | IIb | C |
Mitral valve surgery and excision of the left atrial appendage may be considered for patients with severe MS (MVA ≤1.5 cm2, stages C and D) who have had recurrent embolic events while receiving adequate anticoagulation | IIb | C |
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