Key result
Standard surgical techniques for secondary mitral regurgitation type IIIb yield suboptimal results in ~30% of patients, prompting a review of additional subvalvular reconstructive interventions.
Why the study?
The optimal treatment strategy for secondary mitral regurgitation of Carpentier type IIIb remains debatable, as standard undersized ring annuloplasty yields suboptimal results in some patients.
Does surgical treatment with subvalvular structure interventions improve reverse remodeling of the left ventricle in patients with secondary mitral regurgitation type IIIb?
Does surgical treatment with subvalvular structure interventions improve reverse remodeling of the left ventricle in patients with secondary mitral regurgitation type IIIb?
Answers are grounded in this paper and cite their sources.
Additional reconstructive interventions on subvalvular structures during mitral valve surgery may improve left ventricular reverse remodeling in patients with type IIIb secondary mitral regurgitation.
The optimal treatment strategy for secondary mitral regurgitation of type IIIb (A. Carpentier classification) remains debatable. The use of a standard surgical technique for treating secondary mitral regurgitation and undersized ring annuloplasty demonstrates suboptimal results in several patients (about 30% of the patients exhibit postoperative hemodynamically significant mitral regurgitation with the absence of effective reverse remodelling of the left ventricle). Such suboptimal results are associated with the unification of only the mitral valve reconstruction technique, irrespective of the state of the left ventricle (degree of dysfunction, dilatation, tethering/tenting, and papillary muscle displacement); this is not entirely justified because of the disease complexity (valve and ventricular), and it is crucial to influence both the components of the disease. Particularly, modern researchers are inclined toward the need of using additional reconstructive interventions on the subvalvular structures that contribute to a more effective reverse remodelling of the left ventricle.Here, we present a review of recent studies on the surgical treatment of functional mitral insufficiency of type IIIb (A. Carpentier classification) with effects on the subvalvular structures (pupillary muscle relocation and approximation).Revised 19 April 2020. Revised 5 May 2020. Accepted 28 May 2020.Funding: The study did not have sponsorship.Conflict of interest: Authors declare no conflict of interest.
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Скопин et al. (2020) conducted a review in Secondary mitral regurgitation of type IIIb. Reconstructive interventions on subvalvular structures (papillary muscle relocation and approximation) vs. Standard surgical technique and undersized ring annuloplasty was evaluated. Standard surgical techniques for secondary mitral regurgitation type IIIb yield suboptimal results in ~30% of patients, prompting a review of additional subvalvular reconstructive interventions.
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