Surgical Challenges in Ischemic Mitral Regurgitation

The optimal surgical management of ischemic mitral regurgitation (IMR) seems to have remained a controversial issue due to contradictory outcomes of various relevant studies. In case surgical interventions are considered for a patient with ischemic MVR, the surgeon would face two distinct controversies for treatment. Firstly there’s the controversy of treating moderate ischemia with a concomitant CABG or CABG alone to the ischemic myocardium in order to contribute to adverse remodeling of LV and consequently restoration of subvalvular geometry and reduce regurgitation. There are obviously no debates over the decision of valvular intervention in the setting of severe ischemic mitral regurgitation. So the second controversial issue for a surgeon could be whether repair or replacement is the best treatment method. There are certain echocardiographic and surgical findings that suggest long term results for mitral repair could not be satisfying and they often require other interventional procedures for their residual MR in mid-term follow up. However since reoperation for such patients with patent grafts and some degrees of LV dysfunction could be challenging and may negatively affect the patient’s surgical outcome and quality of life, some authors recommend replacement instead of repair based on patient’s individual characteristics.This presentation aims to investigate various management modalities and provide answers for controversies according to data from the latest clinical trials, recent guidelines and other relevant meta-analysis.