Is there still a role for isolated mitral valve surgery in functional mitral regurgitation? A contemporary review

Functional mitral regurgitation (FMR) is the consequence of a series of geometric and functional alterations in the left ventricle, which precipitate structural changes in the mitral valve (MV). Left ventricular remodeling, whether global or localized, generates abnormal tension or tethering of the papillary muscles and chordae tendineae, thereby compromising proper MV closure. Given that FMR is often associated with coronary artery disease, the surgical indication for concomitant MV surgery with coronary artery bypass grafting (CABG) is unequivocal. However, the surgical indication for isolated MV surgery in patients with FMR without the need for CABG or other concomitant surgical procedures is more contentious. Excluding the indications for non-surgical procedures, this article examines the context and current status of isolated MV surgery in FMR. Furthermore, a potential decision-making algorithm for surgical interventions in patients with FMR is presented, based on the current accumulated evidence.