Modern challenges of surgical management of patients with moderate and borderline ischemic mitral regurgitation

Abstract

One of the most common complications of ischemic heart disease is ischemic mitral regurgitation (IMR). About 20% of patients with coronary artery disease suffer from the onset and progression of IMR. It is more often observed in patients who have suffered a myocardial infarction of the inferior wall of the left ventricle (LV). It is known that the presence of mitral regurgitation (MR) reduces patient survival regardless of the presence of ischemic heart disease. The accumulated experience in the field of diagnosis and tactics of surgical treatment of IMR is currently ambiguous, despite many studies being conducted. In particular, such important problems as determining predictors and risk factors for recurrent IMR after surgical treatment, as well as indications for mitral valve intervention and the choice of surgical technique for correcting moderate and borderline IMR remain unresolved. Determining the risk factors for an unfavorable outcome of each specific method of surgical treatment of borderline IMR will help the specialists make the right decision regarding the treatment of this pathology. This literature review shows the full range of modern surgical methods for the treatment of borderline ischemic mitral dysfunction, evaluates the results of the most common isolated and combined operations, analyzes the risk factors for unfavorable outcome in the long-term period after their implementation, and also offers original approaches to the tactics of surgical treatment of IMR.