Trends in the surgical management of ischemic mitral regurgitation

Hamner, Chad E.; Sundt, Thoralf M.

doi:10.1007/s11886-003-0078-0

Cited by 11 publications

(4 citation statements)

References 38 publications

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“…Not surprisingly, certain clinical factors were associated with reduced survival; these included decreasing ejection fraction, increasing age, worse heart failure, and greater numbers of comorbid conditions. Others have identified similar risk factors for late mortality in patients having surgery for IMR [1,24]. Thus, in surgical patients, the preoperative status is critically important in determining long-term survival.…”

Section: Clinical Impact-survival and Other Outcomesmentioning

confidence: 94%

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Is ischemic mitral regurgitation an indication for surgical repair or replacement?

Gillinov

2006

Heart Fail Rev

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Ischemic mitral regurgitation (IMR) is common in patients with coronary artery disease. While it is well-known that IMR exerts a graded effect upon survival-the greater the degree of IMR, the lower the survival-the indications for surgical treatment and the choice of surgical procedure (repair versus replacement) are controversial. In patients with mild to moderate IMR, the benefit of a mitral valve procedure has not been demonstrated, and surgical practice varies. In patients with severe IMR, mitral valve surgery is the norm, but guidelines for choosing between valve repair and valve replacement do not exist. Furthermore, the survival impact of mitral valve surgery in patients with severe IMR is uncertain. When patients with severe IMR undergo mitral valve surgery, undersized annuloplasty results in durable repair in 70% to 85% of cases. Newly-developed adjunctive repair techniques may further improve results. Currently, mitral valve repair is the procedure of choice in the majority of patients having surgery for severe IMR. However, the most severely ill patients and those with certain echocardiographic characteristics (e.g. severe bileaflet tethering) should be treated with bioprosthetic mitral valve replacement rather than repair.

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Section: Clinical Impact-survival and Other Outcomesmentioning

confidence: 94%

“…As noted previously, when such patients undergo CABG, a mitral valve procedure is generally indicated [4,5,24]. Currently, surgeons favor mitral valve repair for severe functional IMR.…”

Section: Revascularization With Mitral Valve Repairmentioning

confidence: 99%

Is ischemic mitral regurgitation an indication for surgical repair or replacement?

Gillinov

2006

Heart Fail Rev

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“…Several different repair methods of the mitral valve have been investigated, some of which have been put into practical use, including the papillary muscle sling (22), papillary muscle relocation (13), and selective chordal cutting (7). The most commonly used surgical procedure to correct FIMR is coronary artery bypass grafting combined with ring annuloplasty, or either method alone (5,7,10). The results of recent studies (3,17) have shown that 30% of patients had a recurrence of significant ischemic mitral regurgitation during a six-month period after surgery, and that this was increased to 60% after three to five years (5).…”

Section: Discussionmentioning

confidence: 99%

“…Typically, FIMR is seen in between 11% and 59% of patients after myocardial infarction (1). Even with a mild degree of mitral regurgitation, these patients have a mortality risk that is two-to fourfold higher than in those patients without mitral regurgitation within 2 to 16 days after infarction (10).…”

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confidence: 91%

Mitral Valve Mechanics Following Posterior Leaflet Patch Augmentation

Rasmussen

Rahmani

Honge

et al. 2012

5th Biennial Conference on Heart Valve Biology and Tissue Engineering

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Background and aim of the study-Attention towards the optimization of mitral valve repair methods is increasing. Patch augmentation is one strategy used to treat functional ischemic mitral regurgitation (FIMR). The study aim was to investigate the force balance changes in specific chordae tendineae emanating from the posterior papillary muscle in a FIMR-simulated valve, following posterior leaflet patch augmentation.Methods-Mitral valves were obtained from 12 pigs (body weight 80 kg). An in vitro test set-up simulating the left ventricle was used to hold the valves. The left ventricular pressure was regulated with water to simulate different static pressures during valve closure. A standardized oval pericardial patch (17 × 29 mm) was introduced into the posterior leaflet from mid P2 to the end of the P3 scallop. Dedicated miniature transducers were used to record the forces exerted on the chordae tendineae. Data were acquired before and after 12 mm posterior and 5 mm apical posterior papillary muscle displacement to simulate the effect from one of the main contributors of FIMR, before and after patch augmentation.Results-The effect of displacing the posterior papillary muscle induced tethering on the intermediate chordae tendineae to the posterior leaflet, and resulted in a 39.8% force increase (p = 0.014). Posterior leaflet patch augmentation of the FIMR valve induced a 31.1% force decrease (p = 0.007). There was no difference in force between the healthy and the repaired valve simulations (p = 0.773).Conclusion-Posterior leaflet patch augmentation significantly reduced the forces exerted on the intermediate chordae tendineae from the posterior papillary muscle following FIMR simulation. As changes in chordal tension lead to a redistribution of the total stress exerted on the valve, patch augmentation may have an adverse long-term influence on mitral valve function and remodeling.

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Ischemic Mitral Regurgitation: Not Only a Bystander

et al. 2011

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Ischemic mitral regurgitation (MR) is a common complication of left ventricular (LV) dysfunction related to chronic coronary artery disease. This complex multifactorial disease involves global and regional LV remodeling, as well as dysfunction and distortion of the components of the mitral valve including the chordae, the annulus, and the leaflets. Its occurrence is associated with a poor prognosis. The suboptimal results obtained with the most commonly used surgical strategy, involving mitral valve annuloplasty with coronary bypass grafting, emphasize the need to develop alternative surgical techniques targeting the causal mechanisms of the disease. A comprehensive preoperative assessment of mitral valve configuration and LV geometry and function and an accurate quantification of MR severity at rest and during exercise may contribute to improve risk stratification and to tailor the surgical strategy according to the individual characteristics of the patient.

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Trends in the surgical management of ischemic mitral regurgitation

Cited by 11 publications

References 38 publications

Is ischemic mitral regurgitation an indication for surgical repair or replacement?

Is ischemic mitral regurgitation an indication for surgical repair or replacement?

Mitral Valve Mechanics Following Posterior Leaflet Patch Augmentation

Ischemic Mitral Regurgitation: Not Only a Bystander

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