This protocol addresses patients presenting with severe ventricular (secondary/functional) mitral regurgitation in the context of concomitant ischemic heart disease — specifically, coronary artery disease that independently requires revascularization. The co-existence of these two conditions determines how mitral valve management is integrated with coronary intervention.
Severe ischaemic ventricular secondary MR alongside CAD requiring coronary revascularization defines this population. Patient surgical risk profile and coronary anatomy are the pivotal factors that guide the choice of strategy.
The recommended pathway coordinates mitral valve intervention with coronary revascularization. For appropriate candidates, a surgical strategy addressing both conditions together is the primary recommendation. Where surgical risk is elevated or the coronary anatomy favours a percutaneous approach, an alternative catheter-based option for the mitral valve — undertaken after re-evaluation — may be considered.