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Surgical strategy for ischemic mitral regurgitation adopting subvalvular and ventricular procedures

Satoru Wakasa1, Yasushige Shingu, Tomonori Ooka

  • 1Department of Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
|March 6, 2015
PubMed
Abstract

Insights

Surgical strategies combining annuloplasty with additional procedures improve outcomes for ischemic mitral regurgitation (MR) by addressing left ventricular (LV) remodeling and tethering.

Area of Science:

  • Cardiovascular Surgery
  • Cardiac Surgery
  • Heart Valve Repair

Background:

  • Left ventricular (LV) remodeling and mitral valve tethering negatively impact surgical outcomes for ischemic mitral regurgitation (MR).
  • Standard annuloplasty alone may be insufficient for patients with advanced LV disease.

Purpose of the Study:

  • To evaluate the efficacy of a staged surgical approach for ischemic MR, incorporating additional procedures to address LV remodeling and tethering.
  • To compare outcomes of annuloplasty alone versus combined strategies.

Main Methods:

  • A retrospective study of 90 patients undergoing surgical repair for ischemic MR between 1999 and 2013.
  • Patients were divided into three stages: annuloplasty alone (Stage 1), annuloplasty with papillary muscle approximation (PMA) (Stage 2), and annuloplasty with PMA and left ventriculoplasty (Stage 3).

Main Results:

  • Preoperative differences in New York Heart Association (NYHA) class, LV end-diastolic diameter, and LV ejection fraction were significant across stages.
  • Despite baseline differences, mitral regurgitation grades remained comparable postoperatively.
  • Cardiac-related survival and freedom from reoperation rates were similar across all three surgical stages.

Conclusions:

  • Additional submitral and ventricular procedures, including PMA and ventriculoplasty, effectively compensate for impaired outcomes associated with annuloplasty alone.
  • These combined strategies offer a viable solution for ischemic MR in patients with significant LV remodeling and tethering.

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