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Chirurgie 30. April 2013

When to repair ischemic mitral valve regurgitation? An algorithmic approach

Despite huge progress in the surgical management of ischemic mitral regurgitation (IMR) [1–2], there is still controversy regarding the ideal treatment. IMR continues to have a remarkable incidence roughly between 20 and 25 % increasing cardiovascular mortality rate and causing higher probability of heart failure [3–7]. Therefore, cardiac surgeons may have more concern to eliminate a distinct approach this disease.
Although most surgeons would advocate that concomitant mitral valve repair in patients with moderate to severe IMR (defined as grade 3 + or 4 + IMR) undergoing coronary artery bypass grafting (CABG) is beneficial [8–9], the surgical management of moderate IMR still remains under debate.
Some studies demonstrated that CABG alone by resolving perfusion impairment may improve regional wall motion leading to IMR reversal. Moreover, late outcomes of IMR patients who have undergone isolated CABG are acceptable [10–12]. On the other hand, some studies have showed that performing concomitant mitral valve surgery in patients with moderate IMR undergoing CABG would not benefit these patients [13–14]. Patients survival after concomitant IMR repair is still weak regardless of the type of procedure which has been implicated [15]. However, it has been evident that survival with mitral valve replacement is significantly less than repair [16–17]; it was also reported that mortality is nearly the same after mitral valve replacement in comparison with repair [18].
With regard to the controversies in the literatures about the ideal management of each stage of moderate IMR in candidates of CBAG, we conducted the current study to define an algorithmic approach in order to select those patients who will benefit the most from concomitant mitral valve procedure.

F. Roshanali, A. Vedadian, S. Shoar, S. Sandoughdaran, M. Naderan, M Mandegar, European Surgery 2/2013

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