Key result
Surgical treatment for functional mitral regurgitation has evolved to include complex subvalvular and ventricular repairs, though patient prognosis remains heavily dependent on residual left ventricular myocardial function.
Surgical techniques for functional mitral regurgitation have evolved, but patient prognosis remains limited by the extent of underlying ventricular disease.
LV function should guide surgical candidacy in functional MR; leaves open which complex repairs improve outcomes in randomized trials.
Surgery for functional mitral regurgitation (FMR) was reviewed. As the mechanism of FMR is still being elucidated, surgery for FMR, especially ischemic mitral regurgitation evolved from coronary bypass surgery (CABG) with/without mitral valve replacement, to repair mitral leaflet/chordate/papillary muscles and the left ventricle is required. Currently, the best efforts are made regarding the treatment of mitral leaflet tethering or tenting including that of the posterior leaflet and the treatment of ventricular disease. Although the understanding of FMR is increased and the surgical repair technique becomes more sophisticated, prognosis of the patient is not necessarily satisfactory when the amount of residual myocardium is limited. Further investigation is necessary to solve the problem of ventricular disease.
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Komeda et al. (2009) conducted a review in Functional Mitral Regurgitation. Surgical treatment (mitral valve repair/replacement, CABG, left ventricular restoration) was evaluated. Surgical treatment for functional mitral regurgitation has evolved to include complex subvalvular and ventricular repairs, though patient prognosis remains heavily dependent on residual left ventricular myocardial function.
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