Surgical repair of ischemic mitral regurgitation: one ring does not fit all

Abstract

Purpose of review The review summarizes the key parameters that can aid in determining the optimal treatment of ischemic mitral regurgitation (IMR). Recent findings Left ventricular (LV) and mitral valve (MV) parameters are important for surgical planning and risk stratification in IMR. Although LV dimensions is one of the main parameters used in the guidelines, volumes more accurately depict LV remodelling. Furthermore, wall motion abnormalities and wall motion score index can also be useful for surgical planning in treatment of IMR. Viability is best measured with cardiac magnetic resonance, but it is not feasible in certain centres. In contrast, measurement of strain with echocardiography is an emerging and feasible tool for estimating viability. MV leaflet tethering and pattern measured with echocardiography are also useful for MV surgery. Anterior leaflet excursion angle can identify patients in whom undersized ring annuloplasty is potentially unsuitable. Summary Treatment of IMR relies on accurate parameters that can determine the optimal surgical approach. In some patients, lack of viable myocardium suggests inadequacy of revascularization and thus, an adjunctive left ventricular reconstruction may be necessary. Degree and pattern of MV leaflet tethering can indicate whether ring annuloplasty, which is the most common repair technique, is sufficient or an adjunctive sub-valvular intervention is beneficial.

Mitral Valve Repair vs. Replacement by Different Etiologies ― A Nationwide Population-Based Cohort Study ―

“…[39][40][41] The benefits and the appropriate subvalvular techniques for different left ventricular geometry require further investigation. 42…”

Mitral valve repair versus replacement in severe ischemic mitral regurgitation systematic review and meta‐analysis

“…These include coronary artery bypass grafting alone, mitral valve replacement (RPL), and mitral valve repair (RPR), with or without subvalvular procedures. 9 However, the choice of the optimal surgical strategy remains debatable 10,11 and the current guidelines restrict surgical repair only to patients with severe MR and advanced symptoms. 12 The aim of the present meta-analysis is to compare the outcomes of RPR versus RPL regarding perioperative mortality, all-cause late mortality, reoperation, recurrence of MR, and reverse remodeling after surgery.…”

“…However, the choice of the optimal surgical strategy remains debatable 10,11 and the current guidelines restrict surgical repair only to patients with severe MR and advanced symptoms 12 …”