Ischaemic mitral regurgitation in coronary revascularization: A critical gap in surgical guidelines

Abstract

Ischemic mitral regurgitation (IMR) presents a clinical challenge amidst evolving treatment paradigms, particularly when accompanied by coronary artery disease (CAD). Controversies persist regarding the optimal surgical approach, resulting in a lack of definitive guidelines. A comprehensive review of seminal studies from 2000 to 2020 was conducted to elucidate the evolving discourse and treatment landscape for IMR. Studies encompassing varied interventions, including coronary revascularization and concomitant mitral valve procedures, were scrutinized to gauge their impact on patient outcomes. Early studies diverged in advocating for or against adjunct mitral valve intervention during coronary artery bypass grafting (CABG) in IMR patients. Subsequent trials like the POINT and RIME trials highlighted benefits associated with concomitant mitral interventions. However, the Cardiothoracic Surgical Trials Network (CTSN) trials raised concerns regarding adverse events and recurrence rates post-mitral repair.The ambiguity in guidelines for IMR management persists, leaving surgeons to navigate individualized treatment decisions. Recommendations from the American Heart Association (AHA) offer moderate support for mitral valve interventions, yet a clear consensus remains elusive. The necessity for refined guidelines reflecting current evidence is imperative to optimize outcomes in IMR patients.

Keywords: Ischaemic mitral regurgitation, Coronary artery disease, Coronary artery bypass grafting