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Page 18 of 20 Nappi et al. Vessel Plus 2021;5:40 https://dx.doi.org/10.20517/2574-1209.2021.06

To begin, it is necessary to evaluate what was the initial mitral valve approach during the primary surgery.
In the case of repair, we should analyze why the repair failed and if a new repair could be lasting and safe.
We should prefer a replacement performed by surgery or a percutaneous approach if this is not possible. In
this scenario, patient age, previous CABG or aortic surgery, or concomitant necessity of CABG or aortic
surgery, can help us in our choice. In older patients (> 80 years old) with no concomitant necessity of CABG
or aortic surgery, TMViV or TMViR intervention could be the indicated approach with a lower operation
mortality risk and a better long-term outcome. Conversely, in young patients, without comorbidities and
regardless of the concomitant need for CABG or aortic surgery, with a high probability of success of a new
surgical repair/replacement of the valve, a surgical approach, by resternotomy or via right thoracotomy, is
recommended, because of the increased chances of a long-lasting result.

As shown in our results. there are no striking differences in terms of operative or long-term mortality
between surgery and percutaneous reintervention in well selected patients. An important emphasis should
be given to tailor the most suitable, safe and effective approach for the correct patient.

DECLARATIONS
Authors’ contributions
Study design: Nappi F, Verghi E, Chello M
Data acquisition: Nappi F, Verghi E, Avtaar Singh SS, Nenna A, Nappi P
Data interpretation: Nappi F, Verghi E, Nappi P
Manuscript drafting: Nappi F, Verghi E, Avtaar Singh SS, A Nenna
Revision of the manuscript: Nappi F, Chello C, Chello M

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflict of interest
All authors declared that there are no conflicts of interest.

Ethical approval and consent to participate
Not applicable.

Consent for publication
Not applicable.

Copyright
© The Author(s) 2021.

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