Functional mitral regurgitation: The surgeons' perspective

Physicians who are involved in heart failure treatment are regularly confronted with patients who present with functional mitral regurgitation (MR), occurring in a setting of ischaemic or non-ischaemic cardiomyopathy. For these patients, the current guidelines do not offer clear treatment algorithms, and mitral valve surgery is often not advised. This is however not a proper representation of the currently available literature on this topic, and may lead to patients not being evaluated for an intervention from which they may benefit. This chapter deals with the surgical perspective of functional mitral regurgitation. Topics covered are pathophysiology (with its implications for surgical techniques and annuloplasty ring choice), patient assessment and a critical appraisal of the outcome of different surgical approaches. While the focus lies on the results of undersized restrictive annuloplasty, various additional techniques are discussed in order to provide a tailored medico-surgical approach to this difficult subset of patients.