Next Frontier in Functional Mitral Regurgitation

In patients with functional mitral regurgitation, the placement of a sling encircling both papillary muscles in conjunction with mitral annuloplasty appears to be a rational approach for surgical correction, because it addresses both the mitral valve and the deformities of the subvalvular mitral apparatus. Reports in the literature that describe the utilization of this technique are few, and mainly involve a median sternotomy approach. The purpose of this communication is to describe the technical details of performing this procedure via a minimally invasive approach.

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Mitral Annular Remodeling to Treat Functional Mitral Regurgitation: A Pilot Acute Study in a Canine Model

The Heart Surgery Forum ◽

10.1532/hsf98.20101003 ◽

2010 ◽

Vol 13 (4) ◽

pp. E247-E250 ◽

Cited By ~ 4

Author(s):

Hideyuki Fumoto ◽

Tohru Takaseya ◽

Akira Shiose ◽

Roberto M. Saraiva ◽

Yoko Arakawa ◽

...

Keyword(s):

Mitral Regurgitation ◽

Canine Model ◽

Functional Mitral Regurgitation ◽

Acute Study

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Percutaneous Mitral Annuloplasty for Treatment of Functional Mitral Regurgitation

European Cardiology Review ◽

10.15420/ecr.2009.5.1.67 ◽

2009 ◽

Vol 5 (1) ◽

pp. 67

Author(s):

Lutz Buellesfeld ◽

Lazar Mandinov ◽

Eberhard Grube ◽

◽

...

Keyword(s):

Mitral Regurgitation ◽

Coronary Sinus ◽

Standard Of Care ◽

Mitral Annulus ◽

Functional Mitral Regurgitation ◽

Invasive Treatment ◽

Large Variability ◽

Mitral Annuloplasty ◽

Number Of Patients ◽

Anatomical Relationship

Functional mitral regurgitation affects a substantial proportion of patients with congestive heart failure due to myocardial infarction or dilated cardiomyopathy. Functional mitral regurgitation greatly increases morbidity and mortality. Surgical annuloplasty is the standard of care for symptomatic patients with moderate or severe functional mitral regurgitation; however, a large number of patients are refused surgery. Several percutaneous approaches have been developed to address the need for less invasive treatment of mitral annulus dilatation. Devices using coronary sinus to cinch the mitral annulus are relatively easy to use; however, a number of factors may limit their clinical application, such as suboptimal anatomical relationship between the coronary sinus and mitral annulus, risk of coronary artery compression, large variability in the coronary venous anatomy and conflict with other therapies such as ablation or cardiac resynchronisation. Direct mitral annuloplasty is anticipated to be more effective than the coronary sinus approaches; however, it has yet to prove its safety and efficacy in carefully designed clinical trials. The best candidates and the best timing for each percutaneous mitral annuloplasty therapy, whether direct or indirect, have yet to be identified.

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The Results of the Use of Angiotensin Receptor Inhibitors and Neprilisin in Secondary Functional Mitral Regurgitation in Outpatient Practice

Annals of the Russian academy of medical sciences ◽

10.15690/vramn1462 ◽

2020 ◽

Vol 75 (5) ◽

pp. 514-522

Author(s):

Alexey S. Ryazanov ◽

Konstantin I. Kapitonov ◽

Mariya V. Makarovskaya ◽

Alexey A. Kudryavtsev

Keyword(s):

Heart Failure ◽

Left Ventricle ◽

Mitral Regurgitation ◽

Effective Area ◽

Left Ventricular ◽

Functional Mitral Regurgitation ◽

Angiotensin Receptor ◽

Optimal Drug ◽

Patients With Heart Failure ◽

Valsartan Group

Background. Morbidity and mortality in patients with functional mitral regurgitation (FMR) remains high, however, no pharmacological therapy has been proven to be effective.Aimsto study the effect of sacubitrile/valsartan and valsartan on functional mitral regurgitation in chronic heart failure.Methods.This double-blind study randomly assigned sacubitrile/valsartan or valsartan in addition to standard drug therapy for heart failure among 100 patients with heart failure with chronic FMR (secondary to left ventricular (LV) dysfunction). The primary endpoint was a change in the effective area of the regurgitation hole during the 12-month follow-up. Secondary endpoints included changes in the volume of regurgitation, the final systolic volume of the left ventricle, the final diastolic volume of the left ventricle, and the area of incomplete closure of the mitral valves.Results.The decrease in the effective area of the regurgitation hole was significantly more pronounced in the sacubitrile/valsartan group than in the valsartan group (0.070.066against0.030.058sm2; p=0.018)in the treatment efficacy analysis, which included 100patients (100%). The regurgitation volume also significantly decreased in the sacubitrile/valsartan group compared to the valsartan group (mean difference:8.4ml; 95%CI, from 13.2 until 1.9;р=0.21). There were no significant differences between the groups regarding changes in the area ofincomplete closure of the mitral valves and LV volumes, with the exception of the index of the final LV diastolic volume (p=0.07).Conclusion.Among patients with secondary FMR, sacubitril/valsartan reduced MR more than valsartan. Thus, angiotensin receptor inhibitors and neprilysin can be considered for optimal drug treatment of patients with heart failure and FMR.

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