Reparación valvular en la insuficiencia mitral isquémica

Abstract

There is a broad consensus on the negative influence of postinfarction ischemic mitral regurgitation (MR) on patient survival. However, matters such as the need for correction or the moment to perform it remain in scientific discussion. Numerous studies suggest that residual MR after isolated coronary revascularization surgery leads to increased morbimortality, and worsens the prognosis of reoperated patients. On the contrary, concomitant treatment of ischemic cardiopathy and associated MR appears to provide better results, especially in functional terms. However, the current evidences do not allow a clear indication due to the disparity of experimental designs used. The interrelationship between structure and ventricular remodeling with the MR is very important in this context. Thus, mitral valve repair may contribute to reverse left ventricular remodeling, and this, the durability of the procedure, while the progression of remodeling increases recurrence of MR. Mitral valve repair is aimed to restore leaflet coaptation and the elimination of the MR. In order to predict valve reparability, clinical outcome and the likelihood of recurrence different echocardiographic and anthropometric parameters have been defined. Nevertheless, the correct integration of such parameters and their exposure as a clinical guide are still unresolved issues. In this article, we propose some recommendations to establish a consensus on the indications for mitral valve repair.