When should patients with ischemic mitral regurgitation undergo cardiac surgery?

Ischemic mitral regurgitation (MR) results from ischemic left ventricular distortion with tethering of the mitral leaflets. The standard surgical therapy for ischemic MR is mitral ring annuloplasty, often performed at the time of coronary artery bypass surgery. However, ring annuloplasty is associated with an up to 30% recurrence rate of MR, as it does not directly address ventricular distortion and tethering of the mitral leaflets and there is often further ventricular remodeling following bypass surgery. This article reviews the background and mechanism of ischemic MR and unusual approaches to this important yet difficult to treat valvular problem.