title: Are adjunct subvalvular techniques more effective than isolated restrictive annuloplasty for treating ischemic mitral regurgitation?
abstract: This review focused on whether subvalvular techniques are more effective than isolated restrictive annuloplasty in addressing ischemic mitral regurgitation (MR). Searching identified 445 papers and, following a selection process, we ended up with 10 articles. Two were propensity-matched studies, four retrospective and four prospective, non-randomized studies. The end points of interest were late recurrence of MR, other early echocardiographic outcomes of mitral function and early mortality. All studies focusing on echocardiographic measurements showed improved results in the groups where subvalvular repair techniques were used. In almost all studies, the recurrence of MR postoperatively was less when subvalvular techniques were used. No difference in early or in-hospital mortality was demonstrated in all four studies that included comparisons. We conclude that subvalvular techniques in combination with annuloplasty are safe and may better address ischemic MR than the use of annuloplasty ring alone.
authors.affiliation: 1 Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: Leonidas V
authors.initials: LV
authors.lastname: Athanasopoulos
authors.affiliation: 2 Cardiac Surgery Department, Anthea Hospital, GVM Hospitals of Care and Research, Bari, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Moscarelli
authors.affiliation: 2 Cardiac Surgery Department, Anthea Hospital, GVM Hospitals of Care and Research, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Speziale
authors.affiliation: 1 Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: Prakash P
authors.initials: PP
authors.lastname: Punjabi
authors.affiliation: 1 Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK.
authors.forename: Thanos
authors.initials: T
authors.lastname: Athanasiou
mesh_terms: D006348:Cardiac Surgical Procedures / Q000379:methods; D004452:Echocardiography; D006801:Humans; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000379:methods*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D016896:Treatment Outcome
keywords: ischemic mitral regurgitation; mitral valve; papillary muscle; repair; subvalvular