Papillary muscle relocation and mitral annuloplasty in ischemic mitral valve regurgitation: Midterm results

Objectives The Cardiothoracic Surgical Trials Network recently reported no difference in the primary end point of left ventricular end-systolic volume index at 1 year postsurgery in patients randomized to repair (n = 126) or replacement (n = 125) for severe ischemic mitral regurgitation. However, patients undergoing repair experienced significantly more recurrent mitral regurgitation than patients undergoing replacement (32.6% vs 2.3%). We examined whether baseline echocardiographic and clinical characteristics could identify those who will develop moderate/severe recurrent mitral regurgitation or die. Methods Our analysis includes 116 patients who were randomized to and received mitral valve repair. Logistic regression was used to estimate a model-based probability of recurrence or death from baseline factors. Receiver operating characteristic curves were constructed from these estimated probabilities to determine classification cut-points maximizing accuracy of prediction based on sensitivity and specificity. Results Of the 116 patients, 6 received a replacement before leaving the operating room; all other patients had mild or less mitral regurgitation on intraoperative echocardiogram after repair. During the 2-year follow-up period, 76 patients developed moderate/severe mitral regurgitation or died (53 mitral regurgitation recurrences, 13 mitral regurgitation recurrences and death, and 10 deaths). The mechanism for recurrent mitral regurgitation was largely mitral valve leaflet tethering. Our model (including age, body mass index, sex, race, effective regurgitant orifice area, basal aneurysm/dyskinesis, New York Heart Association class, history of coronary artery bypass grafting, percutaneous coronary intervention, or ventricular arrhythmias) yielded an area under the receiver operating characteristic curve of 0.82. Conclusions The model demonstrated good discrimination in identifying patients who will survive 2 years without recurrent mitral regurgitation after mitral valve repair. Although our results require validation, they offer a clinically relevant risk score for selection of surgical candidates for this procedure.

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“…37–40 Other procedures that directly relocate or sling the papillary muscles to decrease leaflet tethering also show promising results. 41–43 …”

Section: Discussionmentioning

confidence: 99%

Predicting recurrent mitral regurgitation after mitral valve repair for severe ischemic mitral regurgitation

Krön

Hung

Overbey

et al. 2015

The Journal of Thoracic and Cardiovascular Surgery

177

116

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“…The anatomical variability of PM has been described within a comprehensive classification which foresees 5 patterns in accordance to the PM shape and number of heads (24). Subvalvular apparatus surgical approaches include the papillary muscle approximation (PMA) (5,19), surgical relocation (20,25), PM sling (21). Type I and II PM are approximated using a CV-4 Gore-Tex suture (W. L. Gore and Associates, Flagstaff, Ariz) placed at the head of each PM.…”

Section: Surgerymentioning

confidence: 99%

Papillary muscle approximation in mitral valve repair for secondary MR

et al. 2017

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“…However, there are other contemporary adjunctive solutions that are available to be considered when the pathoanatomy is not within favorable parameters for restrictive annuloplasty alone. These adjunctive valvular or subvalvular procedures to restrictive annuloplasty include anterior or posterior leaflet augmentation [58,59], intra-ventricular papillary muscle surgical relocation [60], and papillary muscle sling implantation [61,62]. These additive mitral repair strategies have shown promising early-and mid-term results and may be integrated into the armamentarium of surgeons experienced in mitral repair.…”

Section: Secondary Mitral Regurgitationmentioning

confidence: 99%