Papillary muscle relocation in conjunction with valve annuloplasty improve repair results in severe ischemic mitral regurgitation

Fattouch, Khalil; Lancellotti, Patrizio; Castrovinci, Sebastiano; Murana, Giacomo; Sampognaro, Roberta; Corrado, Egle; Caruso, Marco; Saglio, Giuseppe; Novo, Salvatore; Ruvolo, Giovanni

doi:10.1016/j.jtcvs.2011.09.062

Cited by 67 publications

(57 citation statements)

References 9 publications

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“…10,11) In contrast, submitral procedures could be a preferable approach as several studies have advocated their effectiveness. [12][13][14][15][16][17] Suspension of the papillary muscle towards the mitral annulus using papillary muscle relocation 12,13) or the RING+STRING technique 14) is an effective approach to correct tethering at the submitral level. However, this procedure cannot reduce posterior and outward tethering as much as apical tethering because the papillary muscles are retracted toward the mitral annulus.…”

Section: Discussionmentioning

confidence: 99%

Surgical Strategy for Ischemic Mitral Regurgitation Adopting Subvalvular and Ventricular Procedures

Wakasa

Shingu

Ōoka

et al. 2015

ATCS

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Purpose: The progression of left ventricular (LV) remodeling and subsequent mitral valve tethering impair the results of reduction annuloplasty for ischemic mitral regurgitation (MR). Methods: We studied 90 patients who underwent surgical repair of ischemic MR between 1999 and 2013 according to our surgical strategy adding submitral and ventricular procedures to annuloplasty as follows: annuloplasty alone (stage 1, n = 30), additional papillary muscle approximation (PMA) for progression of tethering (stage 2, n = 26), and additional left ventriculoplasty with PMA for progression of LV remodeling and tethering (stage 3, n = 34). Results: The preoperative New York Heart Association (NYHA) functional classes (2.5 ± 0.7, 3.1 ± 0.7 and 3.3 ± 0.7 for stages 1, 2 and 3, respectively, P <0.001), LV end-diastolic diameters (56 ± 7 mm, 66 ± 5 mm and 70 ± 7 mm, P <0.001), and LV ejection fractions (45 ± 12%, 32 ± 9% and 27 ± 9%, P <0.001) significantly differed among the stages. In contrast, the MR grades did not significantly differ (2.9 ± 0.8, 3.0 ± 1.0, and 2.9 ± 1.1, respectively; P = 0.93). Both the rates of cardiac-related survival and freedom from reoperation were comparable among the 3 groups (log-rank P = 0.92 and 0.58, respectively). Conclusion: Additional submitral and ventricular procedures can compensate for the possible impairment of the outcomes after annuloplasty alone for ischemic MR in patients with severe LV remodeling and tethering.

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Section: Discussionmentioning

confidence: 99%

Surgical Strategy for Ischemic Mitral Regurgitation Adopting Subvalvular and Ventricular Procedures

Wakasa

Shingu

Ōoka

et al. 2015

ATCS

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“…However, MAP combined surgical ventricular restoration cannot always eliminate MR when the LV is remarkably remodeled; thus, an additional subvalvular procedure should be PMR corrects tethering at the subvalvular level, relocating an outwardly and apically displaced PMs toward the mitral annulus [3]. The posterior PM is usually a target for relocation in asymmetrical tethering [3] [4]; however, both PMs are targets in symmetrical tethering [5] [10]. Relocation toward the anterior annulus may allow natural directional repositioning of the PMs [4], effectively reducing the distance between the anterior annulus and the displaced PMs [4] and improving the diastolic anterior mitral leaflet excursion [10].…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Reconstruction and Mitral Valve Annuloplasty Combined with Papillary Muscle Relocation for Severe Ischemic Mitral Regurgitation

Furukawa¹,

Yano²,

Nakamura³

et al. 2017

WJCS

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A 46-year-old man was referred to our hospital due to severe ischemic mitral regurgitation with severe bileaflet tethering and a dilated left ventricle. We performed left ventricular reconstruction and mitral valve annuloplasty combined with papillary muscle relocation. Although left ventricular continued remodeling occurred during follow-up, left ventricular reconstruction and mitral valve annuloplasty combined with papillary muscle relocation provided durable mitral repair, and his functional status was good. Thus, this combined surgical treatment may reduce mitral regurgitation recurrence after mitral valve annuloplasty.

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“…19 Secondary MR results from the geometrical distortion of the subval vular apparatus, which occurs secondary to LV enlarge ment and impaired contractility. 3,4,20,21 Secondary MR is a disease of the ventricles rather than of the valves per se, and is classified as type IIIb in Carpentier's surgical clas sification of mitral valve pathology. 11,22 The incidence and clinical importance of secondary MR is largely underestimated, in part owing to the insensitive nature of the physical examination.…”

Section: Factors That Influence Mrmentioning

confidence: 99%

Therapeutic decision-making for patients with fluctuating mitral regurgitation

2015

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| Mitral regurgitation (MR) is a common, progressive, and difficult-to-manage disease. MR is dynamic in nature, with physiological fluctuations occurring in response to various stimuli such as exercise and ischaemia, which can precipitate the development of symptoms and subsequent cardiac events. In both chronic primary and secondary MR, the dynamic behaviour of MR can be reliably examined during stress echocardiography. Dynamic fluctuation of MR can also have prognostic value; patients with a marked increase in regurgitant volume or who exhibit increased systolic pulmonary artery pressure during exercise have lower symptom-free survival than those who do not experience significant changes in MR and systolic pulmonary artery pressure during exercise. Identifying patients who have dynamic MR, and understanding the mechanisms underlying the condition, can potentially influence revascularization strategies (such as the surgical restoration of coronary blood flow) and interventional treatment (including cardiac resynchronization therapy and new approaches targeted to the mitral valve).

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Papillary muscle relocation in conjunction with valve annuloplasty improve repair results in severe ischemic mitral regurgitation

Cited by 67 publications

References 9 publications

Surgical Strategy for Ischemic Mitral Regurgitation Adopting Subvalvular and Ventricular Procedures

Surgical Strategy for Ischemic Mitral Regurgitation Adopting Subvalvular and Ventricular Procedures

Left Ventricular Reconstruction and Mitral Valve Annuloplasty Combined with Papillary Muscle Relocation for Severe Ischemic Mitral Regurgitation

Therapeutic decision-making for patients with fluctuating mitral regurgitation

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