Skip to main content

Mitral Valve Repair for Ischemic Mitral Regurgitation with Advanced Cardiomyopathy

  • Chapter
  • First Online:
Surgical Treatment for Advanced Heart Failure

Abstract

Ischemic mitral regurgitation, a late complication of coronary artery disease, develops secondary to changes in the mitral subvalvular apparatus and left ventricular geometry. Surgical treatment of ischemic mitral regurgitation can improve symptoms of congestive heart failure but has not clearly demonstrated a survival benefit. In this chapter, we discuss the pathophysiology of ischemic mitral regurgitation, experimental and clinical evidence underlying current treatment algorithms, and future areas of investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Hendren WG, Nemec JJ, Lytle BW, Loop FD, Taylor PC, Stewart RW, et al. Mitral valve repair for ischemic mitral insufficiency. Ann Thorac Surg. 1991;52(6):1246–51.

    Article  PubMed  CAS  Google Scholar 

  2. Sabbah HN, Rosman H, Kono T, Alam M, Khaja F, Goldstein S. On the mechanism of functional mitral regurgitation. Am J Cardiol. 1993;72(14):1074–6.

    Article  PubMed  CAS  Google Scholar 

  3. Komeda M, Glasson JR, Bolger AF, Daughters GT, 2nd, MacIsaac A, Oesterle SN, et al. Geometric determinants of ischemic mitral regurgitation. Circulation. 1997;96(9 Suppl):II-128–33.

    Google Scholar 

  4. Trichon BH, Glower DD, Shaw LK, Cabell CH, Anstrom KJ, Felker GM, et al. Survival after coronary revascularization, with and without mitral valve surgery, in patients with ischemic mitral regurgitation. Circulation. 2003;108 Suppl 1:II103–10.

    Google Scholar 

  5. Aklog L, Filsoufi F, Flores KQ, Chen RH, Cohn LH, Nathan NS, et al. Does coronary artery bypass grafting alone correct moderate ischemic mitral regurgitation? Circulation. 2001;104(12 Suppl 1):I68–75.

    PubMed  CAS  Google Scholar 

  6. Bax JJ, Braun J, Somer ST, Klautz R, Holman ER, Versteegh MI, et al. Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodeling. Circulation. 2004;110(11 Suppl 1):II103–8.

    PubMed  Google Scholar 

  7. Grossi EA, Bizekis CS, LaPietra A, Derivaux CC, Galloway AC, Ribakove GH, et al. Late results of isolated mitral annuloplasty for “functional” ischemic mitral insufficiency. J Card Surg. 2001;16(4):328–32.

    Article  PubMed  CAS  Google Scholar 

  8. Mirabel M, Iung B, Baron G, Messika-Zeitoun D, Detaint D, Vanoverschelde JL, et al. What are the characteristics of patients with severe, symptomatic, mitral regurgitation who are denied surgery? Eur Heart J. 2007;28(11):1358–65.

    Article  PubMed  Google Scholar 

  9. Jessup M, Brozena S. Heart failure. N Engl J Med. 2003;348(20):2007–18.

    Article  PubMed  Google Scholar 

  10. He J, Ogden LG, Bazzano LA, Vupputuri S, Loria C, Whelton PK. Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study. Arch Intern Med. 2001;161(7):996–1002.

    Article  PubMed  CAS  Google Scholar 

  11. Aronson D, Goldsher N, Zukermann R, Kapeliovich M, Lessick J, Mutlak D, et al. Ischemic mitral regurgitation and risk of heart failure after myocardial infarction. Arch Intern Med. 2006;166(21):2362–8.

    Article  PubMed  Google Scholar 

  12. Bursi F, Enriquez-Sarano M, Nkomo VT, Jacobsen SJ, Weston SA, Meverden RA, et al. Heart failure and death aftery myocardial infarction in the community: the emerging role of mitral regurgitation. Circulation. 2005;111(3):295–301.

    Article  PubMed  Google Scholar 

  13. Trichon BH, Felker GM, Shaw LK, Cabell CH, O’Connor CM. Relation of frequency and severity of mitral regurgitation to survival among patients with left ventricular systolic dysfunction and heart failure. Am J Cardiol. 2003;91(5):538–43.

    Article  PubMed  Google Scholar 

  14. Grigioni F, Enriquez-Sarano M, Zehr KJ, Bailey KR, Tajik AJ. Ischemic mitral regurgitation: long-term outcome and prognostic implications with quantitative Doppler assessment. Circulation. 2001;103(13):1759–64.

    Article  PubMed  CAS  Google Scholar 

  15. Guy TSt, Moainie SL, Gorman JH, 3rd, Jackson BM, Plappert T, Enomoto Y, et al. Prevention of ischemic mitral regurgitation does not influence the outcome of remodeling after posterolateral myocardial infarction. J Am Coll Cardiol. 2004;43(3):377–83.

    Article  PubMed  Google Scholar 

  16. Beeri R, Yosefy C, Guerrero JL, Abedat S, Handschumacher MD, Stroud RE, et al. Early repair of moderate ischemic mitral regurgitation reverses left ventricular remodeling: a functional and molecular study. Circulation. 2007;116(11 Suppl):I288–93.

    PubMed  Google Scholar 

  17. Abbate A, Biondi-Zoccai GG, Bussani R, Dobrina A, Camilot D, Feroce F, et al. Increased myocardial apoptosis in patients with unfavorable left ventricular remodeling and early symptomatic post-infarction heart failure. J Am Coll Cardiol. 2003;41(5):753–60.

    Article  PubMed  Google Scholar 

  18. Pimentel DR, Amin JK, Xiao L, Miller T, Viereck J, Oliver-Krasinski J, et al. Reactive oxygen species mediate amplitude-dependent hypertrophic and apoptotic responses to mechanical stretch in cardiac myocytes. Circ Res. 2001;89(5):453–60.

    Article  PubMed  CAS  Google Scholar 

  19. Braun J, van de Veire NR, Klautz RJ, Versteegh MI, Holman ER, Westenberg JJ, et al. Restrictive mitral annuloplasty cures ischemic mitral regurgitation and heart failure. Ann Thorac Surg. 2008;85(2):430–6.

    Article  PubMed  Google Scholar 

  20. De Bonis M, Lapenna E, Verzini A, La Canna G, Grimaldi A, Torracca L, et al. Recurrence of mitral regurgitation parallels the absence of left ventricular reverse remodeling after mitral repair in advanced dilated cardiomyopathy. Ann Thorac Surg. 2008;85(3): 932–9.

    Article  PubMed  Google Scholar 

  21. Gillinov AM, Wierup PN, Blackstone EH, Bishay ES, Cosgrove DM, White J, et al. Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg. 2001;122(6):1125–41.

    Article  PubMed  CAS  Google Scholar 

  22. Komeda M, Shimamoto T. Cutting secondary chordae and placing dual taut stitches between the anterior mitral fibrous annulus and the heads of each papillary muscle to treat ischemic mitral regurgitation without deteriorating left ventricular function. J Thorac Cardiovasc Surg. 2008;135(1):226–7.

    Article  PubMed  Google Scholar 

  23. Kron IL, Green GR, Cope JT. Surgical relocation of the posterior papillary muscle in chronic ischemic mitral regurgitation. Ann Thorac Surg. 2002;74(2):600–1.

    Article  PubMed  Google Scholar 

  24. Hvass U, Joudinaud T. The papillary muscle sling for ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2010;139(2):418–23.

    Article  PubMed  Google Scholar 

  25. Kincaid EH, Riley RD, Hines MH, Hammon JW, Kon ND. Anterior leaflet augmentation for ischemic mitral regurgitation. Ann Thorac Surg. 2004;78(2):564–8.

    Article  PubMed  Google Scholar 

  26. Rodriguez F, Langer F, Harrington KB, Tibayan FA, Zasio MK, Liang D, et al. Cutting second-order chords does not prevent acute ischemic mitral regurgitation. Circulation. 2004;110(11 Suppl 1):II91–7.

    PubMed  Google Scholar 

  27. Harris KM, Sundt TM, 3rd, Aeppli D, Sharma R, Barzilai B. Can late survival of patients with moderate ischemic mitral regurgitation be impacted by intervention on the valve? Ann Thorac Surg. 2002;74(5):1468–75.

    Article  PubMed  Google Scholar 

  28. Diodato MD, Moon MR, Pasque MK, Barner HB, Moazami N, Lawton JS, et al. Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: a propensity analysis. Ann Thorac Surg. 2004;78(3):794–9.

    Article  PubMed  Google Scholar 

  29. Ellis SG, Whitlow PL, Raymond RE, Schneider JP. Impact of mitral regurgitation on long-term survival after percutaneous coronary intervention. Am J Cardiol. 2002;89(3):315–8.

    Article  PubMed  Google Scholar 

  30. Calafiore AM, Gallina S, Di Mauro M, Gaeta F, Iaco AL, D’Alessandro S, et al. Mitral valve procedure in dilated cardiomyopathy: repair or replacement? Ann Thorac Surg. 2001;71(4):1146–52.

    Article  PubMed  CAS  Google Scholar 

  31. McGee EC, Gillinov AM, Blackstone EH, Rajeswaran J, Cohen G, Najam F, et al. Recurrent mitral regurgitation after annuloplasty for functional ischemic mitral regurgitation. J Thorac Cardiovasc Surg. 2004;128(6):916–24.

    Article  PubMed  Google Scholar 

  32. Matsunaga A, Tahta SA, Duran CM. Failure of reduction annuloplasty for functional ischemic mitral regurgitation. J Heart Valve Dis. 2004;13(3):390–7. discussion 397–8.

    PubMed  Google Scholar 

  33. Acker MA, Bolling S, Shemin R, Kirklin J, Oh JK, Mann DL, et al. Mitral valve surgery in heart failure: insights from the Acorn Clinical Trial. J Thorac Cardiovasc Surg. 2006;132(3):568–77.

    Article  PubMed  Google Scholar 

  34. Grossi EA, Woo YJ, Patel N, Goldberg JD, Schwartz CF, Subramanian VA, et al. Outcomes of coronary artery bypass grafting and reduction annuloplasty for functional ischemic mitral regurgitation: a prospective multicenter study (Randomized evaluation of a surgical treatment for off-pump repair of the mitral valve). J Thorac Cardiovasc Surg. 2011;141(1):91–7.

    Article  PubMed  Google Scholar 

  35. Grossi EA, Woo YJ, Schwartz CF, Gangahar DM, Subramanian VA, Patel N, et al. Comparison of Coapsys annuloplasty and internal reduction mitral annuloplasty in the randomized treatment of functional ischemic mitral regurgitation: impact on the left ventricle. J Thorac Cardiovasc Surg. 2006;131(5):1095–8.

    Article  PubMed  CAS  Google Scholar 

  36. Grossi EA, Patel N, Woo YJ, Goldberg JD, Schwartz CF, Subramanian V, et al. Outcomes of the RESTOR-MV Trial (Randomized evaluation of a surgical treatment for off-pump repair of the mitral valve). J Am Coll Cardiol. 2010;56(24):1984–93.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Leora B. Balsam M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer Science+Business Media New York

About this chapter

Cite this chapter

Balsam, L.B., Grossi, E.A., Galloway, A. (2013). Mitral Valve Repair for Ischemic Mitral Regurgitation with Advanced Cardiomyopathy. In: Morgan, J., Naka, Y. (eds) Surgical Treatment for Advanced Heart Failure. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6919-3_4

Download citation

  • DOI: https://doi.org/10.1007/978-1-4614-6919-3_4

  • Published:

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6918-6

  • Online ISBN: 978-1-4614-6919-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics