Ischemic mitral regurgitation: when should one intervene?

Kenza Rahmouni; Jasmin H. Shahinian; Mimi Deng; Saqib Qureshi; Joanna Chikwe; Vincent Chan

doi:10.1097/hco.0000000000000916

September 15, 2021Current Opinion in Cardiology

Ischemic mitral regurgitation: when should one intervene?

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Key result

Mitral valve replacement for severe IMR links to fewer HF and CV readmissions versus repair.

Why the study?

Optimal timing of intervention for ischemic mitral regurgitation remains to be elucidated.

Does surgical or transcatheter intervention improve outcomes in patients with ischemic mitral regurgitation?

Key Points

To review current evidence on the diagnostic evaluation, optimal timing, and interventional modalities for managing ischemic mitral regurgitation.
Synthesized contemporary literature on mechanistic classification and noninvasive imaging via transthoracic echocardiography, transesophageal echocardiography, and cardiac MRI.
Evaluated clinical and structural outcomes across coronary revascularization, surgical mitral valve repair, surgical mitral valve replacement, and transcatheter edge-to-edge repair.
Revascularization facilitates left ventricular reverse remodeling in select individuals presenting with moderate ischemic mitral regurgitation.
Mitral valve replacement demonstrates a lower incidence of heart failure events and cardiovascular readmissions compared with mitral valve repair in severe disease, though successful repair affords superior reverse remodeling.
Transcatheter edge-to-edge repair serves as an effective complementary therapy within the multidisciplinary management paradigm.

Structured PICO

Does surgical or transcatheter intervention improve outcomes in patients with ischemic mitral regurgitation?

P

Population

Patients with ischemic mitral regurgitation

I

Intervention

Intervention for ischemic mitral regurgitation (revascularization, mitral valve replacement, mitral valve repair, transcatheter edge-to-edge repair)

A tailored approach utilizing revascularization, surgical replacement or repair, and transcatheter edge-to-edge repair is recommended for managing ischemic mitral regurgitation.

Implication

May favor replacement to reduce readmissions in severe ischemic MR; leaves open need for randomized confirmation.

Abstract

PURPOSE OF REVIEW: Optimal timing of intervention for ischemic mitral regurgitation remains to be elucidated. This review summarizes the data on the management of ischemic mitral regurgitation, and their implications on current practice and future research. RECENT FINDINGS: Mechanistically, ischemic mitral regurgitation can present as Type I, Type IIIb or mixed Type I and IIIb disease. Severity of mitral regurgitation is typically quantified with echocardiography, either transthoracic or transesophageal echocardiography, but may also be assessed via cardiac MRI. In patients with moderate ischemic mitral regurgitation, revascularization can lead to left ventricular reverse remodeling in some. In patients with severe ischemic mitral regurgitation, mitral valve replacement may be associated with fewer adverse events related to heart failure and cardiovascular readmissions, compared with valve repair, although reverse remodeling may be better in patients following successful mitral repair. Transcatheter edge-to-edge repair also further complements the treatment of ischemic mitral regurgitation. SUMMARY: A tailored approach to patients should be considered for each patient presenting with ischemic mitral regurgitation.

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Cite This Study

Rahmouni et al. (2021) studied this question. Mitral valve replacement for severe ischemic mitral regurgitation may be associated with fewer heart failure and cardiovascular readmissions compared to mitral valve repair.

synapsesocial.com/papers/6a0bd7e8dc69176b05a94192 https://doi.org/10.1097/hco.0000000000000916