**3. Mitral valve abnormalities**

Mitral valve bench correction has rarely been performed because of concerns related to the feasibility of repair and durability. The additional ischemic time required to perform valve repair or replacement needs to be taken into account before using a donor heart with valvular dysfunction.

The assessment of mitral valve regurgitation in a donor patient is essential to determine the mechanism, severity, and reversibility of the disease before planning mitral valve repair. A thorough review of the donor echocardiogram should be performed to determine the exact nature and pathology of mitral regurgitation *Role of Concomitant Valve Surgery in Orthotopic Heart Transplant DOI: http://dx.doi.org/10.5772/intechopen.102390*

### **Figure 2.**

*Guidelines for an algorithm for the management of potential heart donors. CVP: central venous pressure; HCT: hematocrit; Hb: hemoglobin; MAP: mean arterial pressure; LVEF: left ventricular ejection fraction; T3: triiodothyronine; SVR: systemic vascular resistance; BG: blood glucose; and PCWP: pulmonary capillary wedge pressure.*

in otherwise acceptable donor hearts. If the mechanism of mitral regurgitation is simple, then bench repair can be performed by increasing the duration of warm ischemia time before transplantation.

However, the evaluation may be compromised by a decrease in afterload resulting from the loss of peripheral vascular tone or inflated by transient ventricular dysfunction [18]. For this purpose, transesophageal echocardiographic evaluation is necessary to understand whether mitral regurgitation is surgically treatable. Therefore, there is sufficient reason to perform bench mitral valve repair without a significant increase in recipient morbidity and mortality. In addition, donor hearts should not show any electrocardiographic or echocardiographic signs of

left ventricular hypertrophy (LVH). The authors believe that in some cases, the presence of mitral regurgitation with moderate pulmonary hypertension may be a protective factor as the right ventricle is preconditioned to a high afterload.
