Are adjunct subvalvular techniques more effective than isolated restrictive annuloplasty for treating ischemic mitral regurgitation?

Abstract

This review focused on whether subvalvular techniques are more effective than isolated restrictive annuloplasty in addressing ischemic mitral regurgitation (MR). Searching identified 445 papers and, following a selection process, we ended up with 10 articles. Two were propensity-matched studies, four retrospective and four prospective, non-randomized studies. The end points of interest were late recurrence of MR, other early echocardiographic outcomes of mitral function and early mortality. All studies focusing on echocardiographic measurements showed improved results in the groups where subvalvular repair techniques were used. In almost all studies, the recurrence of MR postoperatively was less when subvalvular techniques were used. No difference in early or in-hospital mortality was demonstrated in all four studies that included comparisons. We conclude that subvalvular techniques in combination with annuloplasty are safe and may better address ischemic MR than the use of annuloplasty ring alone.

An observational, prospective study on surgical treatment of secondary mitral regurgitation: The SMR study. Rationale, purposes, and protocol

“…Different observational studies, mostly including a small number of patients, reported that adding adjunctive techniques (isolated or in combination) to RMA reduced significantly the prevalence of moderate or more IMR at follow-up compared to cases where RMA alone was used. 46,54,55,[58][59][60][61] A randomized controlled trial from CTS network compared RMA to MV replacement in case of severe IMR. 4,62 Results showed similar survival and LV remodeling, but patients with RMA had higher moderate or more IMR return (58.8% vs 3.8%) and higher heart failure-related events after a 2-year follow-up.…”

“…In selected cases, MV replacement has been proposed, in particular when IMR was severe. Different observational studies, mostly including a small number of patients, reported that adding adjunctive techniques (isolated or in combination) to RMA reduced significantly the prevalence of moderate or more IMR at follow‐up compared to cases where RMA alone was used 46,54,55,58‐61 . A randomized controlled trial from CTS network compared RMA to MV replacement in case of severe IMR 4,62 .…”