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Surgical Treatment of Ischemic Mitral Regurgitation

Eugene Grossi, Aubrey Galloway, David Yaffee
Surgical Treatment of Ischemic Mitral Regurgitation is a topic covered in the Adult and Pediatric Cardiac.

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Introduction

Ischemic mitral valve regurgitation (IMR) occurs as 2 related but distinct complications of myocardial infarction. Acute IMR, as discussed in a previous chapter, results from acute papillary muscle rupture following a myocardial infarction. Patients with acute IMR usually present in extremis and often require urgent surgical intervention with increased perioperative risk.[1] Conversely, chronic IMR (cIMR), which will be the focus of this chapter, is a result of ventricular remodeling following myocardial infarction and has a more indolent progression. Chronic IMR occurs in approximately 25% of patients status after myocardial infarction and in up to half of patients after myocardial infarction with left ventricular dysfunction and heart failure.[2],[3],[4],[5],[6],[7] It is associated with poor outcomes that worsen in direct correlation to the severity of valvular insufficiency,[7],[8],[9],[10],[11],[12],[13],[14] with even mild cIMR resulting in significantly worse outcomes than similar ischemia without cIMR.[4],[5],[15],[16] It is estimated that there will be approximately 790,000 hospitalizations for myocardial infarction in the United States in 2018, or approximately 1 every 40 seconds.[17] As the population ages and the incidence of coronary artery disease increases, the number of patients with cIMR will only continue to grow.

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Introduction

Ischemic mitral valve regurgitation (IMR) occurs as 2 related but distinct complications of myocardial infarction. Acute IMR, as discussed in a previous chapter, results from acute papillary muscle rupture following a myocardial infarction. Patients with acute IMR usually present in extremis and often require urgent surgical intervention with increased perioperative risk.[1] Conversely, chronic IMR (cIMR), which will be the focus of this chapter, is a result of ventricular remodeling following myocardial infarction and has a more indolent progression. Chronic IMR occurs in approximately 25% of patients status after myocardial infarction and in up to half of patients after myocardial infarction with left ventricular dysfunction and heart failure.[2],[3],[4],[5],[6],[7] It is associated with poor outcomes that worsen in direct correlation to the severity of valvular insufficiency,[7],[8],[9],[10],[11],[12],[13],[14] with even mild cIMR resulting in significantly worse outcomes than similar ischemia without cIMR.[4],[5],[15],[16] It is estimated that there will be approximately 790,000 hospitalizations for myocardial infarction in the United States in 2018, or approximately 1 every 40 seconds.[17] As the population ages and the incidence of coronary artery disease increases, the number of patients with cIMR will only continue to grow.

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Last updated: September 4, 2020