This protocol addresses the specific management of patients presenting with severe ventricular secondary mitral regurgitation (SMR) in the setting of concomitant coronary artery disease (CAD) — a scenario where decisions about the mitral valve and coronary anatomy must be evaluated together.
In this population, coordinated management of the mitral valve and coronary disease is central to the recommended strategy. The principal pathway involves surgical intervention on the mitral valve timed with coronary revascularization. For patients at elevated surgical risk where the coronary anatomy permits a catheter-based approach, an alternative pathway exists — details of eligibility, sequencing, and the re-evaluation step are outlined in the full protocol.
MV surgery is recommended in patients with severe ventricular SMR undergoing CABG.
In patients with severe ischaemic ventricular SMR and concomitant CAD requiring coronary revascularization, MV surgery at the time of CABG is recommended, unless the patient is at high surgical risk and/or the coronary anatomy is suitable for PCI.
PCI followed by TEER after re-evaluation of MR may be considered in symptomatic patients with chronic severe ventricular SMR and non-complex CAD.
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