Surgical treatment of secondary mitral regurgitation in heart failure: a present-day view

Abstract

Rationale. Secondary, or functional, mitral regurgitation is the most common complication of heart failure. Dysfunction of one or more mitral valve structures occurs in 39–74% of patients thus complicating the course of the disease and significantly worsening the prognosis in patients with left ventricle dilatation. An unfavorable prognosis in patients with the development of mitral regurgitation is conditioned by the progressive changes that form a vicious circle: the continuing volume overload and dilatation of the left ventricle cause its remodeling, leading to further dilatation of the mitral valve annulus. Dysfunctions of the papillary muscles lead to the increased tension of the left ventricle wall and increased mitral regurgitation. Clinically, this process is manifested by the congestive heart failure progression and worsened prognosis of the further course, which in the future may lead to considering the inclusion of this patient group on the waiting list for heart transplantation.Purpose. The purpose of this article is to review the role of surgical management in patients with heart failure complicated by mitral regurgitation.Conclusions. The main principles of the treatment for functional mitral regurgitation include the reverse left ventricular remodeling and mitral valve repair or replacement surgery which lead to an improved quality of life, the transition of patients to a lower functional class, reduced hospital admission rates, and also to a regression or slower progression of the heart failure and to an improved survival.

Angiotensin receptor-neprilysin inhibitors and cardiac remodeling

“…NT-proBNP is secreted primarily by the ventricular myocardium in response to increased wall stress with increased LV filling pressure (e.g., when expanding the volume of the ventricle or pressure overload) ( 17 ). Elevated serum NT-proBNP level is a predictor for mortality and hospitalization in patients with heart failure and coronary artery diseases or other cardiovascular diseases, as well as in SMR ( 18 ).…”