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Developing a mitral valve center of excellence

El-Eshmawi, Ahmed*; Castillo, Javier, G.; Tang, Gilbert, H.L.; Adams, David, H.*

Current Opinion in Cardiology: March 2018 - Volume 33 - Issue 2 - p 155–161
doi: 10.1097/HCO.0000000000000498
VALVULAR HEART DISEASE: Edited by Bobby Yanagawa and Subodh Verma

Purpose of review Despite the proven superiority of mitral repair over replacement for degenerative mitral disease, mitral valve replacement remains common. Guidelines now recommend referral of patients, particularly those whom are asymptomatic, to valve centers of excellence, although criteria that define such centers remain to be established. The purpose of this review is to define the structure of a mitral center of excellence and to review current clinical outcomes which are possible in such a center.

Recent findings Recently, American College of Cardiology/American Heart Association as well as the European Society of Cardiology/European Association of Cardiothoracic Surgery guidelines define mitral centers of excellence as either centers in which the likelihood of successful and durable repair exceeds 95% and with an operative mortality risk of less than 1% (American College of Cardiology/American Heart Association definition) or centers with high repair rates, low operative mortality, and a record of durable results (European Society of Cardiology/European Association of Cardiothoracic Surgery definition). There is however less clarity about the structure and function of a center that achieves these outcomes.

Summary The importance of centers of excellence in mitral valve surgery are now well recognized, and this review will highlight the key components and outcomes of an established mitral valve reference center.

Department of Cardiovascular Surgery, Icahn School of Medicine at Mount Sinai, Mount Sinai Hospital, Mount Sinai Health System, New York City, New York, USA

Correspondence to Ahmed El-Eshmawi, MD, Department of Cardiovascular Surgery, Mount Sinai Hospital, 1190 Fifth Ave, GP2W, Box 1028, New York, New York 10029, USA. Tel: +1 212 659 6820; fax: +212 659 6818; e-mail:

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