Update on surgical repair in functional mitral valve regurgitation.

Abstract

Background: Functional mitral regurgitation (FMR) is common in patients\nwith myocardial infarction or dilated cardiomyopathies, and portends a\npoor prognosis despite guideline-directed medical therapy. Surgical or\ntranscatheter mitral repair for FMR from recent randomized clinical\ntrials showed disappointing or conflicting results. Aims: To provide an\nupdate on the role of surgical repair in the management of FMR.\nMaterials & Methods: A literature search was conducted utilizing\nPubMed, Ovid, Web of Science, Embase and Cochrane Library. The search\nterms included secondary/functional mitral regurgitation, ischemic\nmitral regurgitation, mitral repair, mitral replacement, mitral\nannuloplasty, transcatheter mitral repair, and percutaneous mitral\nrepair. Randomized clinical trials over the past decade were the\nparticular focus of this current review. Results: Recent data underlined\nthe complexity and poor prognosis of FMR. Guideline-directed medical\ntherapy and cardiac resynchronization, when indicated, should always be\napplied. Accurate assessment of the interplay between ventricular\ngeometry and mitral valve function is essential to differentiate\nproportionate FMR from the disproportionate subgroup, which could be\nhelpful in selecting appropriate transcatheter intervention strategies.\nSurgical repair, most commonly performed with an undersized ring\nannuloplasty, remains controversial. Adjunctive valvular or subvalvular\nrepair techniques are evolving and may produce improved results in\nselected FMR patients. Conclusion: FMR resulted from complex\nvalve-ventricular interaction and remodeling. Distinguishing\nproportionate FMR from disproportionate FMR is important in exploring\ntheir underlying mechanisms and to guide medical treatment with surgical\nor transcatheter interventions. Further studies are warranted to confirm\nthe clinical benefit of appropriate surgical repair in selected FMR\npatients.