Mitral valve repair in heart failure

Abstract

Ž. Mitral regurgitation MR is a frequent complication of end-stage heart failure. Historically, these patients were either managed medically or with mitral valve replacement, both associated with poor outcomes. Mitral valve repair via an 'undersized' annuloplasty repair is safe and effectively corrects MR in heart-failure patients. All of the observed changes contribute to reverse remodeling and restoration of the normal left-ventricular geometric relationship. Mitral valve repair offers a new strategy for patients with MR and end-stage heart failure. ᮊ European Society of Cardiology. All rights reserved.Ž .

Apparently normal mitral valves in patients with heart failure demonstrate biochemical and structural derangements

“…Mitral regurgitation (MR) is present in more than half of all patients with ischemic or idiopathic dilated cardiomyopathy (DCM) resulting in congestive heart failure (CHF) (1,2).…”

Mitral insufficiency and morbidity and mortality in left ventricular dysfunction

“…Recently, several surgical series have reported encouraging results with mitral annuloplasty in patients with NYHA class III or IV symptoms, low ejection fraction and severe functional mitral insufficiency (13,(22)(23)(24). Survival at one and two years is comparable with that of recent medical trials, while the functional class appears to be much better (3,13). To date, however, there is no direct comparison between medical and surgical therapy for patients with heart failure and mitral insufficiency.…”

Changes in Left Ventricular Function and Dimension After Surgical Ventricular Restoration With or Without Concomitant Mitral Valve Procedure

“…1 Although it is well accepted that severe MR should be repaired at the time of CABG in cases of ischemic MR, there is less consensus about the indications for surgery in patients with grade 2 or 3 MR, and it is uncertain if concomitant MAP during SVR is beneficial in patients with I-CMP and MR. [2][3][4] Because ischemic MR results from remodeling of the ischemic LV, a standard therapeutic approach to relieve ischemic MR is ring annuloplasty, which reduces the mitral annular area by bringing the dilated posterior annulus anteriorly to reduce the anterior -posterior dimension and thus bring the leaflets into apposition. [5][6][7] Bolling et al 8 performed MAP using an undersized circumferential ring to reduce the annulus in severe MR associated with I-CMP, and based on their mid-term results they emphasized that MAP in endstage cardiomyopathy was a new and effective strategy. However, many recent studies report recurrent or persistent MR early after MAP as a result of progressive remodeling of the dilated failing LV.…”