Coronary artery bypass grafting and mitral valve surgery

With an ageing population and expected increases in the prevalence of heart failure, there will likely be more patients presenting with ischaemic mitral regurgitation (IMR). Multiple studies have shown that surgery can be performed safely in this patient population. Randomized trials have now addressed whether mitral valve repair should be performed concomitantly with coronary artery bypass grafting in the setting of moderate IMR, and whether mitral valve repair or replacement is superior in the setting of severe IMR. Novel percutaneous technologies to address the mitral valve are also in evolution. This chapter provides an overview of IMR including surgical indications, operative techniques, a review of randomized trial data, and percutaneous approaches for mitral valve disease.