title: Mitral valve surgery in low ejection fraction, severe ischemic mitral regurgitation patients:  should we repair them all?
abstract: OBJECTIVE
  The optimal surgical treatment of chronic ischemic mitral regurgitation still is the subject of much debate in the surgical and cardiological communities. Although combined restrictive mitral annuloplasty and revascularization has demonstrated good results with regard to improvement of clinical status, low rates of recurrent mitral regurgitation and sustained left ventricular reverse remodeling, a survival benefit still has not been demonstrated. In addition, not all patients improve. Remaining issues in this field relate to identification of patients who will benefit from treatment, and to further improve and individualize treatment modalities.
  
  
  RESULTS
  More data support the use of restrictive mitral annuloplasty and revascularization. New surgical techniques to improve mitral competence (posterior leaflet augmentation) and to promote left ventricular reverse remodeling in severely dilated hearts (addressing the subvalvular apparatus) are promising. Disease-specific annuloplasty rings have not (yet) proven additional value. New imaging modalities are available to assess the many components that constitute the complex pathophysiology of remodeling.
  
  
  CONCLUSIONS
  The remaining challenge for cardiologists and surgeons is how to integrate data from different imaging techniques that assess mitral valve geometry and left ventricular size, geometry, function and potential functional recovery in order to individualize and optimize the surgical approach to patients with chronic ischemic mitral regurgitation.
authors.affiliation: Department of Cardiothoracic Surgery, Leids Universitair Medisch Centrum, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
authors.forename: Jerry
authors.initials: J
authors.lastname: Braun
authors.forename: Robert J M
authors.initials: RJ
authors.lastname: Klautz
mesh_terms: D001026:Coronary Artery Bypass; D003657:Decision Making; D006801:Humans; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D017202:Myocardial Ischemia / Q000150:complications* / Q000601:surgery; D013318:Stroke Volume; D016896:Treatment Outcome; D020257:Ventricular Remodeling