Surgical Treatment of Ischemic Mitral Regurgitation
Ischemic mitral valve regurgitation (IMR)  occurs as two related but distinct complications of myocardial infarction. Acute IMR (aIMR), as discussed in a previous chapter, may result from acute papillary muscle rupture following myocardial infarction. Patients with acute IMR usually present in extremis and often require urgent surgical intervention with increased perioperative risk. 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 following myocardial infarction and in up to half of patients after myocardial infarction with left ventricular (LV) dysfunction and heart failure. It is associated with poor outcomes that worsen in direct correlation to the severity of valvular insufficiency, with even mild cIMR resulting in significantly worse outcomes than similar ischemia without cIMR. There were an estimated 1,181,000 hospitalizations for myocardial infarction in the United States in 2018, or approximately 1 every 27 seconds. 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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