Key result
Restrictive annuloplasty alone for moderate ischemic mitral regurgitation is often associated with high recurrence rates due to continuous ventricular remodeling, suggesting a need for more aggressive subvalvular repair procedures.
Why the study?
What is the optimal surgical management strategy for patients with moderate ischemic mitral regurgitation?
What is the optimal surgical management strategy for patients with moderate ischemic mitral regurgitation?
The surgical management of moderate ischemic mitral regurgitation remains controversial, with emerging subvalvular procedures aiming to address the high recurrence rates seen with standard annuloplasty.
Caution warranted with annuloplasty alone in moderate IMR; leaves open optimal subvalvular strategies pending randomized trials.
Ischemic mitral regurgitation (IMR) represents a common complication after myocardial infarction. The valve is anatomically normal and the incompetence is the result of papillary muscles displacement and annular dilatation, causing leaflets tethering. Functionally the leaflets present a restricted systolic motion due to tethering forces that displaces the coaptation surface toward the left ventricle apex. The patients present poor left ventricular function at the time of surgery and the severity of the mitral regurgitation increases the risk of mortality. Currently there is general agreement to treat surgically severe IMR nevertheless strong evidences for patient with moderate insufficiency remains poor and proper treatment debated. The most effective surgical approach for the treatment of IMR remains debated. Some authors demonstrated that coronary artery bypass graft (CABG) alone is beneficial in patients with IMR. Conversely, in most patients, moderate IMR will persist or worsen after CABG alone which translate in higher long-term mortality as a function of residual mitral regurgitation severity. A probable reason for this unclear surgical management of functional MR is due to the contemporary suboptimal results of reparative techniques. The standard surgical treatment of chronic IMR is CABG associated with undersized annuloplasty using complete ring. Though, the recurrence of mitral regurgitation remains high (> 30%) because of continous left ventricle remodeling. To get better long term results, in the last decade, several subvalvular procedures in adjunct to mitral anuloplasty have been developed. Among them, surgical papillary muscle relocation represents the most appreciated option capable to restore normal left ventricle geometry. In the next future new preoperative predictors of increased mitral regurgitation recurrence are certainly needed to find an individual time period of treatment in each patient with moderate IMR.
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Khalil Fattouch (2014) conducted a review in Moderate ischemic mitral valve regurgitation. Surgical management (CABG with or without mitral valve repair) was evaluated. Restrictive annuloplasty alone for moderate ischemic mitral regurgitation is often associated with high recurrence rates due to continuous ventricular remodeling, suggesting a need for more aggressive subvalvular repair procedures.
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