Translational Approach to Heart Failure by Jozef Bartunek & Marc Vanderheyden

Author:Jozef Bartunek & Marc Vanderheyden
Language: eng
Format: epub
Publisher: Springer New York, New York, NY

Exercise echocardiography should be performed in patients with heart failure symptoms and non-significant MR at rest.

Cardiac MRI may have additional value in the assessment of patients with functional MR.

8 Results of Surgery for Ischaemic Mitral Regurgitation

The optimal treatment for ischaemic MR is a subject of ongoing debate in the surgical and cardiology community. Published reports convey ambiguous messages and are essentially difficult to compare because of different patient populations, different definitions of ischaemic MR, different surgical techniques and different follow-up. This controversy is reflected in the guidelines as well. For ischaemic MR, all recommendations have a “C” level of evidence in the European guidelines since randomized trials are absent [41]. For symptomatic patients with severe MR, EF < 30 % and revascularization options, mitral valve surgery has a class IIa recommendation. The same is true for patients with moderate MR undergoing CABG if repair is feasible. Patients with severe MR, EF > 30 %, no revascularization options and low comorbidity have a class IIb recommendation for mitral valve surgery. The American guidelines state that the indication for mitral valve surgery in CABG patients with mild to moderate MR is still unclear, but that there are data indicating benefit of mitral valve repair in such patients [40]. They also state that CABG alone is usually insufficient and leaves many patients with significant residual MR; such patients “would benefit from concomitant mitral valve repair at the time of the CABG”. Finally, it is stated that mitral annuloplasty alone with a downsized annuloplasty ring is often effective at relieving MR.

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