Mitral valve repair for functional mitral regurgitation: is annuloplasty alone enough?

Abstract

To outline indications and contraindications to mitral valve surgery in the clinical context of dilated cardiomyopathy and the surgical principles to follow in performing an undersized annuloplasty. Moreover, we will describe the characteristics of the patients for whom an annuloplasty alone is unlikely to provide an effective result and for whom,therefore, some other procedures or mitral valve replacement should be preferred. In functional mitral regurgitation, competence of the mitral valve can be restored by using a restrictive annuloplasty. This procedure leads to symptomatic improvement and reverse left ventricular remodeling in a substantial proportion of patients. However, the failure rate of undersized annuloplasty is still high and is mainly due to inappropriate patient selection and to technical issues that have been progressively identified. In the treatment of functional mitral regurgitation, annuloplasty alone should only be carried out in the early phase of the disease before the occurrence of advanced left ventricular remodeling and echocardiographic predictors of unfavorable outcome should be taken into account. Under certain circumstances, surgery should include additional procedures apart from annuloplasty to enhance the durability of the repair. Mitral valve replacement should be considered when unsatisfactory results are expected with mitral valve repair due to advanced left ventricular remodeling and long-lasting heart failure.