Heart Failure Reviews

, Volume 19, Issue 3, pp 341–358

Functional mitral regurgitation: a 30-year unresolved surgical journey from valve replacement to complex valve repairs

  • Francesco Onorati
  • Francesco Santini
  • Rajesh Dandale
  • Andrea Rossi
  • Esther Campopiano
  • Konstantinos Pechlivanidis
  • Daniele Calzaferri
  • Aldo Milano
  • Alessandro Mazzucco
  • Giuseppe Faggian
Article

DOI: 10.1007/s10741-013-9392-9

Cite this article as:
Onorati, F., Santini, F., Dandale, R. et al. Heart Fail Rev (2014) 19: 341. doi:10.1007/s10741-013-9392-9

Abstract

Functional mitral regurgitation remains one of the most complex and controversial aspect—for both clinicians and surgeons—in the management of mitral valve disease in the context of left ventricular dysfunction. Given the current absence of clear guidelines, as well as of results from randomized trials comparing the outcome of different surgical strategies potentially available for this complex scenario, surgical decision making for these high-risk patients poses a real dilemma in the daily practice. The resulting surgical choices often represent a questionable combination of surgeons’ personal feeling, local supplies, patients’ life expectancy and risk/benefit ratios, opinions and statements of the experts, and so on. This review provides an overview of the present knowledge about the complex pathophysiology underlying functional mitral regurgitation, the different pathophysiology-guided surgical techniques suggested in the last decades, as well as the current results following these different surgical techniques.

Keywords

Functional mitral regurgitation Chronic ischemic mitral regurgitation Restrictive annuloplasty Mitral valve replacement Mitral valve repair 

List of abbreviations

CSD

Cardiac support device

FMR

Functional mitral regurgitation

LV

Left ventricle

LVEF

Left ventricular ejection fraction

MV

Mitral valve

MVrep

Mitral valve repair

NYHA

New York Heart Association

PM

Papillary muscle

RMA

Restrictive mitral annuloplasty

SVR

Surgical ventricular restoration

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Francesco Onorati
    • 1
  • Francesco Santini
    • 2
  • Rajesh Dandale
    • 1
  • Andrea Rossi
    • 3
  • Esther Campopiano
    • 4
  • Konstantinos Pechlivanidis
    • 1
  • Daniele Calzaferri
    • 1
  • Aldo Milano
    • 1
  • Alessandro Mazzucco
    • 1
  • Giuseppe Faggian
    • 1
  1. 1.Division of Cardiac SurgeryUniversity of Verona Medical SchoolVeronaItaly
  2. 2.Division of Cardiac SurgeryUniversity of GenoaGenoaItaly
  3. 3.Division of CardiologyUniversity of Verona Medical SchoolVeronaItaly
  4. 4.Division of CardiologyNegrar HospitalVeronaItaly