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Ischaemic mitral regurgitation in coronary revascularization: A critical gap in surgical guidelines

Rahul Bhushan1, Vijay Grover1

  • 1Department of CTVS, ABVIMS and Dr RML Hospital, New Delhi, 110001, India.

Journal of Cardiovascular and Thoracic Research
|August 27, 2025
PubMed

Insights

Managing ischemic mitral regurgitation (IMR) with coronary artery disease (CAD) remains complex. Current evidence offers mixed results on surgical interventions, necessitating clearer guidelines for optimal patient outcomes.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Clinical Medicine

Background:

  • Ischemic mitral regurgitation (IMR) poses a significant clinical challenge, especially when co-occurring with coronary artery disease (CAD).
  • Treatment paradigms for IMR are evolving, yet controversies persist regarding the optimal surgical approach, leading to a lack of definitive clinical guidelines.
  • The management of IMR requires careful consideration due to its complexity and the ongoing debate surrounding surgical interventions.

Purpose of the Study:

  • To review and analyze the evolving discourse and treatment landscape for ischemic mitral regurgitation (IMR) from 2000 to 2020.
  • To elucidate the impact of various interventions, including coronary revascularization and mitral valve procedures, on patient outcomes in IMR.
  • To identify the persistent ambiguities in IMR management guidelines and the need for evidence-based recommendations.

Main Methods:

  • A comprehensive literature review of seminal studies published between 2000 and 2020 was conducted.
  • Studies focusing on interventions for IMR, such as coronary artery bypass grafting (CABG) with or without mitral valve intervention, were critically evaluated.
  • Data on patient outcomes, adverse events, and recurrence rates following different surgical approaches were scrutinized.

Main Results:

  • Early studies presented conflicting views on the necessity of adjunct mitral valve intervention during CABG for IMR.
  • Subsequent trials (e.g., POINT, RIME) suggested benefits of concomitant mitral interventions, while the Cardiothoracic Surgical Trials Network (CTSN) trials raised concerns about adverse events and repair durability.
  • Current guidelines from organizations like the American Heart Association (AHA) offer moderate support but lack a clear consensus on mitral valve interventions for IMR.

Conclusions:

  • The optimal surgical management for ischemic mitral regurgitation (IMR) in patients with coronary artery disease (CAD) remains controversial.
  • Despite some evidence supporting concomitant mitral interventions, concerns regarding adverse events and recurrence persist, contributing to guideline ambiguity.
  • There is an imperative need for refined clinical guidelines based on current evidence to optimize treatment strategies and improve outcomes for IMR patients.

Keywords:
Coronary artery bypass graftingCoronary artery diseaseIschaemic mitral regurgitation

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