The frequency, impact, and management of mitral regurgitation in patients with heart failure.

Management of severe chronic mitral regurgitation (MR) in severe heart failure is challenging. There are controversies over the efficacy of surgical correction of MR in the presence of severely depressed left ventricular (LV) function. The etiology of MR plays an important role in clinical decision making. In organic MR, surgical correction should be performed even if patients have an LV ejection fraction of less than or equal to 30%. In functional MR, treatment of myocardial damage should be considered as the priority. The long-term mortality benefit of surgical correction of functional MR associated with severe LV dysfunction caused by cardiomyopathy (ischemic or dilated) likely depends on whether myocardial dysfunction can be reversed or improved by treatments (eg, coronary artery revascularization, pharmacologic treatment). Preoperative examination of viable myocardium (ischemic and hibernating myocardium) helps to identify a surgical candidate with ischemic MR associated with ischemic cardiomyopathy. The role of device treatment of MR in heart failure needs further investigation with outcome data.