Potential Causes of Failed Surgery in Mitral Valve Repair
There are different repair surgeries for IMR patients. Also, the mitral
valve replacement has two options of mechanical and bioprosthetic.
Despite failure of the two randomized controlled trials, mitral valve
repair is still a viable option. The post-hoc analysis of the CTSN
studies have demonstrated that in patients who had good repair with less
than mild MR, the LVESVI and LV reverse remodeling was in favor of the
repair patients compared to the replacement. Bouma et. al have
meticulously investigated the causes of failed repair in patients
undergoing IMR reparative surgery. The most sensitive and specific
finding was the sphericity index of the LV with 100% sensitivity and
specificity, followed by posterior tethering angle >39.5
degrees with 100% senility and 95% specificity [49]. Furthermore,
the basal/posterior aneurysm or dyskinesis was also associated with
higher incidence of failed mitral valve repair despite a resistive
mitral annular correction. Although tenting height and area have been
previously recognized as important markers of failed repair in IMR,
these findings were specific but not sensitive. The patient selection
continues to be one of the most challenging steps to impact the outcome
of these patients.