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Indirect Annuloplasty to Treat Functional Mitral Regurgitation: Current Results and Future Perspectives

The incidence of mitral regurgitation (MR) is approximately 1.7% in the developed world, and this increases to more than 10% in patients aged over 75 years. Functional (or secondary) mitral regurgitation (FMR) is defined as poor leaflet coaptation and tethering secondary to either ischemic or non-is...

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Autores principales: Patterson, Tiffany, Adams, Heath, Allen, Christopher, Rajani, Ronak, Prendergast, Bernard, Redwood, Simon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536087/
https://www.ncbi.nlm.nih.gov/pubmed/31165074
http://dx.doi.org/10.3389/fcvm.2019.00060
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author Patterson, Tiffany
Adams, Heath
Allen, Christopher
Rajani, Ronak
Prendergast, Bernard
Redwood, Simon
author_facet Patterson, Tiffany
Adams, Heath
Allen, Christopher
Rajani, Ronak
Prendergast, Bernard
Redwood, Simon
author_sort Patterson, Tiffany
collection PubMed
description The incidence of mitral regurgitation (MR) is approximately 1.7% in the developed world, and this increases to more than 10% in patients aged over 75 years. Functional (or secondary) mitral regurgitation (FMR) is defined as poor leaflet coaptation and tethering secondary to either ischemic or non-ischemic left ventricular (LV) dysfunction and dilatation. FMR is more common than degenerative (or primary) MR and is associated with significantly worse outcomes in patients with heart failure, post myocardial infarction and following coronary artery bypass graft surgery. Patients with severe degenerative MR have excellent outcomes with surgical repair, however the benefits of surgery in FMR are less clear. Although annuloplasty is associated with a lower operative mortality compared to replacement, the recurrence rate of mitral regurgitation is high in patients with FMR and neither surgical repair or replacement have been shown to reduce hospitalisation or death in FMR. Furthermore, nearly half of patients are deemed too high risk for surgery and therefore most patients are managed conservatively and there remains an unmet clinical need. Transcatheter mitral valve interventions are an emerging alternative for those at high surgical risk. This mini review focuses on indirect mitral annuloplasty: anatomical considerations, patient selection, current devices, implantation techniques and the associated clinical outcome data.
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spelling pubmed-65360872019-06-04 Indirect Annuloplasty to Treat Functional Mitral Regurgitation: Current Results and Future Perspectives Patterson, Tiffany Adams, Heath Allen, Christopher Rajani, Ronak Prendergast, Bernard Redwood, Simon Front Cardiovasc Med Cardiovascular Medicine The incidence of mitral regurgitation (MR) is approximately 1.7% in the developed world, and this increases to more than 10% in patients aged over 75 years. Functional (or secondary) mitral regurgitation (FMR) is defined as poor leaflet coaptation and tethering secondary to either ischemic or non-ischemic left ventricular (LV) dysfunction and dilatation. FMR is more common than degenerative (or primary) MR and is associated with significantly worse outcomes in patients with heart failure, post myocardial infarction and following coronary artery bypass graft surgery. Patients with severe degenerative MR have excellent outcomes with surgical repair, however the benefits of surgery in FMR are less clear. Although annuloplasty is associated with a lower operative mortality compared to replacement, the recurrence rate of mitral regurgitation is high in patients with FMR and neither surgical repair or replacement have been shown to reduce hospitalisation or death in FMR. Furthermore, nearly half of patients are deemed too high risk for surgery and therefore most patients are managed conservatively and there remains an unmet clinical need. Transcatheter mitral valve interventions are an emerging alternative for those at high surgical risk. This mini review focuses on indirect mitral annuloplasty: anatomical considerations, patient selection, current devices, implantation techniques and the associated clinical outcome data. Frontiers Media S.A. 2019-05-17 /pmc/articles/PMC6536087/ /pubmed/31165074 http://dx.doi.org/10.3389/fcvm.2019.00060 Text en Copyright © 2019 Patterson, Adams, Allen, Rajani, Prendergast and Redwood. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Patterson, Tiffany
Adams, Heath
Allen, Christopher
Rajani, Ronak
Prendergast, Bernard
Redwood, Simon
Indirect Annuloplasty to Treat Functional Mitral Regurgitation: Current Results and Future Perspectives
title Indirect Annuloplasty to Treat Functional Mitral Regurgitation: Current Results and Future Perspectives
title_full Indirect Annuloplasty to Treat Functional Mitral Regurgitation: Current Results and Future Perspectives
title_fullStr Indirect Annuloplasty to Treat Functional Mitral Regurgitation: Current Results and Future Perspectives
title_full_unstemmed Indirect Annuloplasty to Treat Functional Mitral Regurgitation: Current Results and Future Perspectives
title_short Indirect Annuloplasty to Treat Functional Mitral Regurgitation: Current Results and Future Perspectives
title_sort indirect annuloplasty to treat functional mitral regurgitation: current results and future perspectives
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6536087/
https://www.ncbi.nlm.nih.gov/pubmed/31165074
http://dx.doi.org/10.3389/fcvm.2019.00060
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