Surgical treatment of secondary mitral regurgitation in heart failure: a present-day view

Abstract

Rationale.Secondary, or functional, mitral regurgitation is the most common complication of heart failure. Dysfunctionof one or more mitral valve structures occurs in 39–74% of patients thus complicating the course of the disease andsignificantly worsening the prognosis in patients with left ventricle dilatation. An unfavorable prognosis in patientswith the development of mitral regurgitation is conditioned by the progressive changes that form a vicious circle: thecontinuing volume overload and dilatation of the left ventricle cause its remodeling, leading to further dilatation ofthe mitral valve annulus. Dysfunctions of the papillary muscles lead to the increased tension of the left ventricle walland increased mitral regurgitation. Clinically, this process is manifested by the congestive heart failure progression andworsened prognosis of the further course, which in the future may lead to considering the inclusion of this patient groupon the waiting list for heart transplantation.Purpose.The purpose of this article is to review the role of surgical management in patients with heart failure complicatedby mitral regurgitation.Conclusions.The main principles of the treatment for functional mitral regurgitation include the reverse left ventricularremodeling and mitral valve repair or replacement surgery which lead to an improved quality of life, the transition ofpatients to a lower functional class, reduced hospital admission rates, and also to a regression or slower progression of theheart failure and to an improved survival.