Subvalvular techniques for ischemic mitral regurgitation

Surgical treatment of ischemic mitral regurgitation with reduction ring annuloplasty is the current standard of practice, yet recurrence in a third of patients limits the benefi t of this approach. In an effort to improve outcomes, attention has turned to understanding the contribution of leaflet tethering in this disease process. Subvalvular techniques to alleviate leaflet restriction have been shown to be safe, and in the appropriate patient population decrease recurrence of ischemic mitral regurgitation when combined with reduction annuloplasty. We describe our preferred technique of posterior papillary muscle repositioning. Further understanding of the preoperative parameters that predict recurrence, and deployment of concomitant subvalvular repair techniques in this subset of patients will be the next important breakthrough in the surgical treatment of ischemic mitral regurgitation.