Comparing surgical techniques and results of secondary ischemic mitral regurgitation: a state-of-the-art literature review.

Abstract

Background and objective: Surgery for mitral valve disease is a developing area with a wide range of surgical options. There is growing evidence on the best approach for secondary ischemic mitral regurgitation (SIMR) when the pathology is within the ventricle. The goal of this literature review is to provide a comprehensive comparison of surgical treatments for SIMR.

Methods: The initial screening process included PubMed, Medline and Embase to identify randomized controlled trials, propensity-matched observational series, meta-analyses and unmatched observational series. The terms used were 'mitral valve disease', 'secondary mitral regurgitation', 'secondary ischemic mitral regurgitation', 'functional mitral regurgitation', 'restrictive mitral annuloplasty', 'subvalvular repair', 'Trans Catheter Edge to Edge Repair and echocardiography coupled with secondary mitral regurgitation', 'secondary ischemic mitral regurgitation', and 'functional mitral regurgitation'. Six strategies have been identified for treating SIMR. These include mitral valve replacement (MVR), restrictive mitral annuloplasty, surgical revascularisation (with and without mitral annuloplasty), subvalvular procedures [papillary muscle (PM) approximation, PM relocation, ring and string procedure], procedures directly targeting the mitral valve (edge-to-edge repair and anterior leaflet enlargement), and transcatheter heart valve therapy.

Key content and findings: There is a deficiency of robust empirical data to enable meaningful comparisons between MVR, mitral valve repair (including subvalvular repair), and transcatheter mitral valve procedure. This review will definitively analyze the current outcomes of transcatheter mitral valve procedure using the edge-to-edge mitral valve repair technique and standard surgical mitral valve procedures in patients with secondary mitral regurgitation (MR). In addition, the seminar highlights the role of left ventricular assist devices in managing SIMR. It discusses the advantages and limitations of each intervention.

Conclusions: Currently, there is no consensus on the optimal management strategy for patients with SIMR. Therefore, a multidisciplinary cardiac team should manage patients with secondary MR to ensure the best outcome by matching the ideal intervention with the patient.