Francesco Nappi1, Antonio Nenna2, Christos Mihos3, Cristiano Spadaccio4, Federico Gentile5, Massimo Chello2, Yoshiro Matzui6. 1. Cardiac Surgery, Centre Cardiologique du Nord, 36 Rue des Moulins Gémeaux, 93200, Saint-Denis, France. francesconappi2@gmail.com. 2. Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy. 3. Echocardiography Laboratory, Columbia University, Mount Sinai Heart Institute, Miami, USA. 4. Cardiothoracic Surgery, Golden Jubilee National Hospital, Glasgow, UK. 5. Cardiovascular Disease Diagnostic Medical Center, Naples, Italy. 6. Cardiovascular and Thoracic Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan.
Abstract
OBJECTIVE: The current treatment of ischemic functional mitral regurgitation (FMR) remains debated due to differences in inclusion criteria of randomized studies and baseline characteristics. Also, the role of left ventricular pathophysiology and the role of subvalvular apparatus have not been thoroughly investigated in recent literature. METHODS: A literature search was performed from PubMed inception to June 2020. RESULTS: Novel concepts of pathophysiology, such as the proportionate/disproportionate conceptual framework, the role of papillary muscles and left ventricular dysfunction, the impact of myocardial ischemia and revascularization, left ventricular remodeling, and the effect of restrictive annuloplasty or subvalvular procedures have been reviewed. CONCLUSIONS: The clinical benefits associated with the use of MitraClip is more evident in patients with disproportionate FMR with greater and sustained left ventricular reverse remodeling. Importantly, in the absence of myocardial revascularization, expansion of myocardial scar tissue and non-perfused areas of ischemic myocardium occur with time, and this impact on outcomes with a longer follow-up period cannot be quantified. In advanced phases of FMR, neither mitral ring annuloplasty nor percutaneous therapies could significantly modify the established pathoanatomic alterations.
OBJECTIVE: The current treatment of ischemic functional mitral regurgitation (FMR) remains debated due to differences in inclusion criteria of randomized studies and baseline characteristics. Also, the role of left ventricular pathophysiology and the role of subvalvular apparatus have not been thoroughly investigated in recent literature. METHODS: A literature search was performed from PubMed inception to June 2020. RESULTS: Novel concepts of pathophysiology, such as the proportionate/disproportionate conceptual framework, the role of papillary muscles and left ventricular dysfunction, the impact of myocardial ischemia and revascularization, left ventricular remodeling, and the effect of restrictive annuloplasty or subvalvular procedures have been reviewed. CONCLUSIONS: The clinical benefits associated with the use of MitraClip is more evident in patients with disproportionate FMR with greater and sustained left ventricular reverse remodeling. Importantly, in the absence of myocardial revascularization, expansion of myocardial scar tissue and non-perfused areas of ischemic myocardium occur with time, and this impact on outcomes with a longer follow-up period cannot be quantified. In advanced phases of FMR, neither mitral ring annuloplasty nor percutaneous therapies could significantly modify the established pathoanatomic alterations.
Authors: Eva Harmel; Jonas Pausch; Tatiana Gross; Jana Petersen; Christoph Sinning; Jens Kubitz; Hermann Reichenspurner; Evaldas Girdauskas Journal: Ann Thorac Surg Date: 2019-06-27 Impact factor: 4.330
Authors: Gregg W Stone; JoAnn Lindenfeld; William T Abraham; Saibal Kar; D Scott Lim; Jacob M Mishell; Brian Whisenant; Paul A Grayburn; Michael Rinaldi; Samir R Kapadia; Vivek Rajagopal; Ian J Sarembock; Andreas Brieke; Steven O Marx; David J Cohen; Neil J Weissman; Michael J Mack Journal: N Engl J Med Date: 2018-09-23 Impact factor: 91.245
Authors: Daniel Goldstein; Alan J Moskowitz; Annetine C Gelijns; Gorav Ailawadi; Michael K Parides; Louis P Perrault; Judy W Hung; Pierre Voisine; Francois Dagenais; A Marc Gillinov; Vinod Thourani; Michael Argenziano; James S Gammie; Michael Mack; Philippe Demers; Pavan Atluri; Eric A Rose; Karen O'Sullivan; Deborah L Williams; Emilia Bagiella; Robert E Michler; Richard D Weisel; Marissa A Miller; Nancy L Geller; Wendy C Taddei-Peters; Peter K Smith; Ellen Moquete; Jessica R Overbey; Irving L Kron; Patrick T O'Gara; Michael A Acker Journal: N Engl J Med Date: 2015-11-09 Impact factor: 91.245