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Mitral regurgitation should be corrected in patients with dilated cardiomyopathy

Nature Clinical Practice Cardiovascular Medicine volume 5, pages 452–453 (2008)Cite this article

Mitral regurgitation (MR) is defined as 'functional' when the mitral valve leaflets are anatomically normal, but are unable to coapt properly because of annular dilation and restricted leaflet motion secondary to increased left ventricular (LV) size and sphericity. Functional MR is commonly observed in patients with dilated cardiomyopathy and is an independent risk factor for poor prognosis.1 There is no doubt that increasing degrees of MR are associated with progressively worse outcomes—the 5-year survival rate can be as low as 29% (± 9%) among patients with an effective regurgitant orifice area of 20 mm² or more.2

Surgical correction of functional MR is controversial, because MR is the consequence, and not the cause, of LV dysfunction. The patient's prognosis is, therefore, more closely related to the underlying cardiomyopathic process than to MR, and the elimination of a low-pressure run-off might worsen the afterload on the left ventricle. Some observational and retrospective studies have indicated that, in patients with dilated cardiomyopathy and functional MR, valve repair does not improve survival in comparison with medical therapy alone.3,4 By contrast, a retrospective propensity analysis by Harris and coworkers, reported that mitral repair does improve survival over myocardial revascularization alone in patients with advanced heart failure (HF; NYHA III–IV) and functional MR.5 Each of these studies,3,4,5 however, suffers from the same important limitations that prevent final conclusions from being drawn—retrospective design, unreported rate of MR recurrence, and unreported changes in patient symptoms, LV size, and cardiac function. With the lack of rigorous randomized clinical trials, the impact on survival of surgical treatment for functional MR remains to be demonstrated. A properly designed study would quite possibly identify specific groups of patients who would derive a significant survival advantage from mitral repair; a procedure that has become progressively more effective, with the use of complete, rigid, and smaller rings.6

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Authors and Affiliations

  1. M De Bonis is a Staff Surgeon and O Alfieri is Professor of Cardiac Surgery and Head of the Cardiac Surgery Department at the San Raffaele University Hospital in Milan, Italy. Professor Alfieri is also a member of the Advisory Board of Nature Clinical Practice Cardiovascular Medicine.,

    Michele De Bonis & Ottavio Alfieri

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  1. Michele De Bonis
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  2. Ottavio Alfieri
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Correspondence to Michele De Bonis.

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The authors declare no competing financial interests.

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De Bonis, M., Alfieri, O. Mitral regurgitation should be corrected in patients with dilated cardiomyopathy. Nat Rev Cardiol 5, 452–453 (2008). https://doi.org/10.1038/ncpcardio1256

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