title: Surgical Treatment of Ischemic Mitral Regurgitation: Valve Repair Versus Replacement.
abstract: Ischemic mitral regurgitation (MR), which occurs in about 20-30% patients with a prior myocardial infarction, is associated with worsening heart failure and an increase in cardiovascular mortality. It should be treated surgically if certain hemodynamic severity criteria are met and in patients who continue to experience symptoms of heart failure despite optimal medical therapy. However, current guidelines do not suggest which of the available approaches to mitral valve surgery-mitral valve (MV) repair or replacement (MVR) is superior for this indication. While MV repair is reported to confer improved survival, MVR may provide higher rates of freedom from recurrent MR. This article attempts to provide the reader with a comprehensive review and comparison of current techniques of mitral valve surgery in patients with severe ischemic MR.
  
  
  
  The first randomized trial to compare MV repair versus MVR in patients with severe ischemic MR, the Cardiothoracic Surgical Trials Network (CTSN) trial, was recently concluded and reported no significant difference in the primary outcome of left ventricular end systolic volume index between the two approaches at either 1- or 2-year follow-ups. Data comparing approaches of MV repair and MVR for ischemic MR is largely limited to small, non-randomized retrospective trials. The only randomized trial data to examine this issue suggested no difference in mortality with either MVR or MV repair; however, MVR was shown to be consistently associated with higher rates of MR recurrence. Certain echocardiographic features have been reported to predict poor outcomes with MVR and may help refine the selection of the surgical approach in the individual patient.
authors.affiliation: Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, NY, 11203, USA. abhisheksharma4mamc@gmail.com.|Institute of Cardiovascular Research and Technology, Brooklyn, NY, USA. abhisheksharma4mamc@gmail.com.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Division of Cardiology, St. Luke's University Health Network, Bethlehem, PA, USA.
authors.forename: Sahil
authors.initials: S
authors.lastname: Agrawal
authors.affiliation: Department of Cardiology, Maimonides Medical Center, New York, NY, USA.
authors.forename: Sunny
authors.initials: S
authors.lastname: Goel
authors.affiliation: Division of Cardiovascular Medicine, State University of New York Downstate Medical Center, Brooklyn, New York, NY, 11203, USA.|The Howard Gilman Institute for Heart Valve Diseases and the Schiavone Institute for Cardiovascular Translational Research, State University of New York Downstate Medical Center, Brooklyn, New York, NY, USA.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Borer
mesh_terms: D004452:Echocardiography; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000503:physiopathology / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012008:Recurrence; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Ischemic mitral regurgitation; Mitral valve repair; Mitral valve replacement