Mitral Valve Repair in the Treatment of Heart Failure.

Heart failure continues to be one of the leading causes of hospitalizations and mortality in the United States. Mitral valve regurgitation in patients with heart failure is most often a functional abnormality and as such represents a different disease entity from other more common causes of regurgitation. In general, in patients with heart failure the mitral valve structure is normal; however, regurgitation is secondary to changes in left ventricular (LV) structure and function, including mitral annular dilatation and changes in LV geometry. Mitral regurgitation affects almost all patients with heart failure as a preterminal or terminal event, and carries a high morbidity and mortality. Medical management is limited to treatment with diuretics and afterload reduction. Unfortunately, once significant amounts of mitral regurgitation are manifest, medical treatment alone is generally associated with poor long-term survival and outcome. Surgical treatment by means of undersized annuloplasty type repairs has shown great promise, for preventing worsening heart failure and improving overall LV function.