Surgical treatment of secondary mitral regurgitation in heart failure: a present-day view
https://doi.org/10.23873/2074-0506-2021-13-1-40-48
Abstract
Rationale. Secondary, or functional, mitral regurgitation is the most common complication of heart failure. Dysfunction of one or more mitral valve structures occurs in 39–74% of patients thus complicating the course of the disease and significantly worsening the prognosis in patients with left ventricle dilatation. An unfavorable prognosis in patients with the development of mitral regurgitation is conditioned by the progressive changes that form a vicious circle: the continuing volume overload and dilatation of the left ventricle cause its remodeling, leading to further dilatation of the mitral valve annulus. Dysfunctions of the papillary muscles lead to the increased tension of the left ventricle wall and increased mitral regurgitation. Clinically, this process is manifested by the congestive heart failure progression and worsened prognosis of the further course, which in the future may lead to considering the inclusion of this patient group on 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 complicated by mitral regurgitation.
Conclusions. The main principles of the treatment for functional mitral regurgitation include the reverse left ventricular remodeling and mitral valve repair or replacement surgery which lead to an improved quality of life, the transition of patients to a lower functional class, reduced hospital admission rates, and also to a regression or slower progression of the heart failure and to an improved survival.
About the Authors
E. G. Agafonov
Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
Russian Federation
Russian Federation
Evgeniy G. Agafonov, Research Associate at the Department of Cardiac Surgery
61/2 Shchepkin St., Moscow 129110
M. A. Popov
Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
Russian Federation
Russian Federation
Mikhail A. Popov, Research Associate at the Department of Cardiac Surgery, Cardiovascular Surgeon
61/2 Shchepkin St., Moscow 129110
D. I. Zybin
Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
Russian Federation
Russian Federation
Dmitriy I. Zybin, Cand. Sci. (Med.), Head of the Department of Cardiac Surgery
61/2 Shchepkin St., Moscow 129110
D. V. Shumakov
Moscow Regional Research and Clinical Institute n.a. M.F. Vladimirskiy
Russian Federation
Russian Federation
Dmitriy V. Shumakov, Corresponding Member of the Russian Academy of Sciences, Prof., Head of the Department of Surgery of Heart and Vessels
61/2 Shchepkin St., Moscow 129110
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For citations:
Agafonov E.G., Popov M.A., Zybin D.I., Shumakov D.V. Surgical treatment of secondary mitral regurgitation in heart failure: a present-day view. Transplantologiya. The Russian Journal of Transplantation. 2021;13(1):40-48. https://doi.org/10.23873/2074-0506-2021-13-1-40-48
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