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Surgical Treatment of Ischemic Mitral Regurgitation: Valve Repair Versus Replacement

  • Ischemic Heart Disease (D Mukherjee, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Ischemic mitral regurgitation (MR), which occurs in about 20–30% patients with a prior myocardial infarction, is associated with worsening heart failure and an increase in cardiovascular mortality. It should be treated surgically if certain hemodynamic severity criteria are met and in patients who continue to experience symptoms of heart failure despite optimal medical therapy. However, current guidelines do not suggest which of the available approaches to mitral valve surgery-mitral valve (MV) repair or replacement (MVR) is superior for this indication. While MV repair is reported to confer improved survival, MVR may provide higher rates of freedom from recurrent MR. This article attempts to provide the reader with a comprehensive review and comparison of current techniques of mitral valve surgery in patients with severe ischemic MR.

Recent Findings

The first randomized trial to compare MV repair versus MVR in patients with severe ischemic MR, the Cardiothoracic Surgical Trials Network (CTSN) trial, was recently concluded and reported no significant difference in the primary outcome of left ventricular end systolic volume index between the two approaches at either 1- or 2-year follow-ups.

Summary

Data comparing approaches of MV repair and MVR for ischemic MR is largely limited to small, non-randomized retrospective trials. The only randomized trial data to examine this issue suggested no difference in mortality with either MVR or MV repair; however, MVR was shown to be consistently associated with higher rates of MR recurrence. Certain echocardiographic features have been reported to predict poor outcomes with MVR and may help refine the selection of the surgical approach in the individual patient.

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Abbreviations

CSTN:

Cardiothoracic Surgical Trials Network

LV:

Left ventricle

LVESVI:

Left Ventricular End Systolic Volume Index

MR:

Mitral regurgitation

MV:

Mitral valve

MVR:

Mitral valve replacement

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Authors and Affiliations

  1. Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, NY, 11203, USA

    Abhishek Sharma & Jeffrey S. Borer

  2. Institute of Cardiovascular Research and Technology, Brooklyn, NY, USA

    Abhishek Sharma

  3. Division of Cardiology, St. Luke’s University Health Network, Bethlehem, PA, USA

    Sahil Agrawal

  4. Department of Cardiology, Maimonides Medical Center, New York, NY, USA

    Sunny Goel

  5. The Howard Gilman Institute for Heart Valve Diseases and the Schiavone Institute for Cardiovascular Translational Research, State University of New York Downstate Medical Center, Brooklyn, New York, NY, USA

    Jeffrey S. Borer

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  1. Abhishek Sharma
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Correspondence to Abhishek Sharma.

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Abhishek Sharma, Sahil Agrawal, Sunny Goel, and Jeffrey S. Borer declare that they have no conflict of interest.

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Sharma, A., Agrawal, S., Goel, S. et al. Surgical Treatment of Ischemic Mitral Regurgitation: Valve Repair Versus Replacement. Curr Cardiol Rep 19, 3 (2017). https://doi.org/10.1007/s11886-017-0813-6

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