Article Text

other Versions

PDF
Secondary mitral regurgitation (part 2): deliberations on mitral surgery and transcatheter repair
  1. William H Gaasch1,2,
  2. Theo E Meyer3
  1. 1Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
  2. 2Tufts University School of Medicine, Boston, Massachusetts, USA
  3. 3University of Massachusetts Medical Center, Worcester, Massachusetts, USA
  1. Correspondence to Dr William H Gaasch, Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington MA 01805, USA; William.h.gaasch{at}lahey.org

Abstract

Secondary mitral regurgitation (MR) develops as a consequence of postinfarction remodelling of the ventricle or other causes of left ventricular (LV) dilatation and dysfunction. The presence of MR amplifies the poor prognosis of the failing ventricle, but it has not been established whether the adverse outcomes stem from the MR or whether the MR is simply a marker of progressive LV dysfunction. In this article, an attempt will be made to clarify the clinical impact of mitral surgery and transcatheter repair in patients with secondary MR. Observational studies indicate symptomatic improvement, but the results of randomised trials are mixed. Furthermore, neither mitral surgery nor transcatheter repair consistently leads to reversal of the adverse LV remodelling. There is, however, general agreement that these procedures do not have a salutary effect on survival. Certainly mitral surgery and transcatheter repair can substantially reduce the mitral regurgitant flow, but inconsistencies and uncertainties regarding clinical outcomes persist in the published literature. Some such problems could be resolved by utilisation of more accurate and reproducible imaging modalities in randomised studies of patients who are most likely to benefit from a reduction in the regurgitant volume—namely those with the most severe MR.

  • heart failure
  • mitral annuloplasty
  • mitral regurgitation

Statistics from Altmetric.com

Footnotes

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles