title: Mitral valve repair for ischemic mitral regurgitation: review of current techniques.
abstract: BACKGROUND
  Ischemic mitral regurgitation can be defined as moderate to severe mitral leak precipitated by acute myocardial infarction. Valve repair is now the procedure of choice, but some cases can pose difficult anatomy. This review will illustrate current techniques for repairing complex ischemic mitral regurgitation.
  
  
  METHODS
  Most patients with ischemic mitral regurgitation have predominant annular dilatation at the posterior commissure and require only ring annuloplasty. Full rigid rings are used preferentially. With leaflet tethering, adjunctive autologous pericardial patches are effective in restoring leaflet coaptation. If papillary muscle elongation or rupture occurs, Gore-Tex artificial chordal replacement performs well. With ischemic mitral regurgitation accompanying posterior ventricular aneurysms, standard trans-atrial mitral repair provides the best results, with associated aneurysms being repaired concurrently.
  
  
  RESULTS
  Surgical approaches and technical outcomes of mitral repair in ischemic mitral regurgitation are illustrated in 5 patients using operative images and echocardiograms. Each method is illustrated, including ring annuloplasty, pericardial leaflet augmentation, artificial chordal replacement, and ventricular aneurysm repair. Using these techniques, virtually all ischemic mitral regurgitation can be repaired, with consequential patient benefits, even in the most complex anatomy.
  
  
  CONCLUSIONS
  Ischemic mitral regurgitation has been shown to have better outcomes when managed with valve repair. Using combinations of annular, leaflet, and chordal procedures, even complex ischemic mitral regurgitation can undergo autologous reconstruction with excellent long-term results.
authors.affiliation: Centennial Medical Center and Vanderbilt University, Nashville, TN.
authors.forename: J S
authors.initials: JS
authors.lastname: Rankin
authors.affiliation: Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: M A
authors.initials: MA
authors.lastname: Daneshmand
authors.affiliation: Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: C A
authors.initials: CA
authors.lastname: Milano
authors.affiliation: Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: J G
authors.initials: JG
authors.lastname: Gaca
authors.affiliation: Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: D D
authors.initials: DD
authors.lastname: Glower
authors.affiliation: Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, NC.
authors.forename: P K
authors.initials: PK
authors.lastname: Smith
keywords: ischemic mitral regurgitation; mitral valve repair; survival analysis