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.