Exploring the Operative Strategy for Secondary Mitral Regurgitation: A Systematic Review

• Published in: BioMed research international 2021, Vol.2021 (1), p.3466813-3466813
• Main Authors: Nappi, Francesco, Singh, Sanjeet Singh Avtaar, Bellomo, Francesca, Nappi, Pierluigi, Chello, Camilla, Iervolino, Adelaide, Chello, Massimo
• Format: Article
• Language: English
• Subjects: Analysis; Apoptosis; Automation; Bias; Care and treatment; Clinical trials; Enlargement; Fibrosis; Heart; Heart Valve Prosthesis Implantation; Heart valve replacement; Heart valves; Humans; Literature reviews; Methods; Mitral valve; Mitral Valve Annuloplasty; Mitral valve insufficiency; Mitral Valve Insufficiency - surgery; Muscles; Myocardial revascularization; Papillary Muscles - pathology; Patients; Registration; Regurgitation; Relocation; Review; Rheumatic heart disease; ROC Curve; Surgery; Systematic review; Treatment Outcome; Vascular implants; Vascular Surgical Procedures; Ventricle; Ventricular assist devices
• ISSN: 2314-6133; 2314-6141
• DOI: 10.1155/2021/3466813

Background. Mitral valve disease surgery is an evolving field with multiple possible interventions. There is an increasing body of evidence regarding the optimal strategy in secondary mitral regurgitation where the pathology lies within the ventricle. We conducted a systematic review to identify the benefits and limitations of each surgical option. Methods. A systematic review of the literature was performed to identify pertinent randomized controlled trials (RCTs), propensity-matched observational series, and meta-analyses which were considered initially and followed by unmatched observational series using the MEDLINE, Ovid EMBASE, and Cochrane Library. Results. We identified 6 different strategies for treating secondary mitral valve regurgitation: mitral valve replacement, restrictive mitral annuloplasty, surgical revascularization (with and without mitral annuloplasty), subvalvular procedures (papillary muscle approximation, papillary muscle relocation, ring and string procedure), and procedures directly targeting the mitral valve (edge-to-edge repair and anterior leaflet enlargement) alongside transcatheter heart valve therapy. We also highlighted the role of left ventricular assist devices in the management of this condition. The benefits and limitations of each intervention are highlighted. Conclusion. There is currently no unanimous and shared strategy for the optimal treatment of patients with secondary IMR. The management of patients with secondary mitral regurgitation must be entrusted to a multidisciplinary Heart Team to ensure ideal intervention and patient matching for the best outcomes.