Surgery for chronic ischemic mitral regurgitation – which mitral intervention?

Abstract

Surgical management of ischemic mitral regurgitation is associated with higher operative mortality, increased morbidity and poorer long-term survival. Selection of the most appropriate surgical treatment to maximize survival could be challenging due to factors such as inconsistent usage of contemporary surgical techniques, inconsistent classification schemes for the entity, paucity of long-term data in order to compare alternatives and an absence of randomized trials of valve repair versus valve replacement. In addition, there is a lack of patient-reported outcome measures and functional data parameters that take into consideration the patient’s perspective in refining the decision making of the therapeutic strategy. In fact, such trials are difficult and if they were to be conducted there would be a high risk of dubious conclusions owing to clustering of outcomes with surgical expertise. This article aims to review the options for surgical management of chronic ischemic mitral regurgitation. It also attempts to identify areas of future research in order to clarify which of these are of priority and will realistically seek for relevant answers. Mitral intervention in this patient group seems to improve survival, although it is dependent on producing a competent mitral apparatus. There is no convincing evidence that repair is superior to replacement, and there is the possibility that the literature has been biased against replacement as the treatment of choice.

Keywords::

• ischemic heart disease
• mitral regurgitation
• mitral valve repair
• mitral valve replacement

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

No writing assistance was utilized in the production of this manuscript.

Notes

CABG: Coronary artery bypass grafting; LV: Left ventricular; MR: Mitral regurgitation; MV: Mitral valve.