Shifting surgical strategies in ischemic mitral regurgitation
EXPERT ANALYSIS FROM THE CARDIOVASCULAR CONFERENCE AT SNOWMASS
Although mitral annuloplasty remains the current standard of care for repair of severe ischemic MR in 2015, “we’re realizing this isn’t necessarily the right thing to do” because of that high recurrent MR rate, Dr. Thourani said. There is a growing understanding that a subannular component is required to achieve a truly successful repair. A variety of promising subannular approaches are being developed. He is particularly enthusiastic about his own group’s work involving creation of a papillary muscle sling to achieve papillary approximation – the results have been encouraging in roughly 40 treated sheep and pigs. Human studies are coming.
Ischemic MR develops secondary to an acute MI, which imposes volume overload on the left ventricle, with increasing wall stress, left ventricular remodeling and heart failure, papillary muscle disarray, annular dilation, and MR. The incidence of heart failure within 5 years is threefold higher if an MI occurs with ischemic MR than without it, the surgeon observed.
The CSTN studies were sponsored by the National Institutes of Health and the Canadian Institutes of Health. Dr. Thourani reported serving as a consultant to Edwards Lifesciences and St. Jude Medical and receiving research grants from Abbott, Boston Scientific, Medtronic, and Sorin.
