Papillary muscle sling: a new functional approach to mitral repair in patients with ischemic left ventricular dysfunction and functional mitral regurgitation

Hvass, Ulrik; Tapia, Michel; Baron, Frank; Pouzet, Bruno; Shafy, Abdel

doi:10.1016/s0003-4975(02)04678-7

Cited by 187 publications

(101 citation statements)

References 3 publications

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“…Differences in the technical caveats and effects on the MV apparatus of these interventions should be mentioned, as the choice of subvalvular intervention must be individualized for each patient. With a restrictive circular polytetrafluoroethylene graft to approximate the papillary muscles, the interpapillary muscle distance is reduced, which ameliorates the posterolateral papillary muscle displacement (26,27). This restores a more anatomic subtending position of the papillary muscles, and may be of greater benefit in patients with a prior inferior myocardial infarction and asymmetric MV tethering (28).…”

Section: Discussionmentioning

confidence: 99%

Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies

Mihos¹,

Xydas²,

Yucel³

et al. 2017

J. Thorac. Dis.

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Background: Combining a ring annuloplasty (Ring) with a mitral subvalvular intervention (Ring + subvalvular) in patients with secondary mitral regurgitation (MR) may improve mitral valve (MV) repair durability. However, the outcomes of this strategy compared with a Ring only, have not been clearly defined.Methods: A systematic review and meta-analysis was performed utilizing randomized controlled and propensity matched studies which compared a Ring + subvalvular versus Ring MV repair for the treatment of secondary MR. Risk ratio (RR), weighted mean difference (MD), and the 95% confidence interval (CI) were P=0.0001) and a greater ejection fraction (MD =2.64%, 95% CI, 0.13-5.15; P=0.04); and, (IV) an improved MV apparatus geometry. There were no differences in operative mortality, post-operative morbidity, or follow-up survival between surgical approaches. Conclusions: When compared with Ring only, a Ring + subvalvular MV repair is associated with greater LV reverse remodeling and systolic function, less recurrence of moderate or greater MR, and an improved geometry of the MV apparatus at short and mid-term follow-up.

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Section: Discussionmentioning

confidence: 99%

Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies

Mihos¹,

Xydas²,

Yucel³

et al. 2017

J. Thorac. Dis.

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“…Furthermore, under-sizing annuloplasty may prevent diastolic annular relaxation resulting in relative mitral stenosis and limited exercise capacity [45]. Whilst, procedures to address leaflet tethering such as chordal cutting, Dor Procedure, papillary muscle slings, and relocation have been described, these are difficult to standardize [46]. In fact, differing surgical approaches using right thoracotomy or minimally invasive approach for MVS have been shown to improve safety and efficacy endpoints [47].…”

Section: Discussionmentioning

confidence: 99%

MitraClip for severe symptomatic mitral regurgitation in patients at high surgical risk

Philip

Athappan

Tuzcu

et al. 2014

Cathet Cardio Intervent

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Background: The optimal treatment of patients with severe mitral regurgitation (MR) at high surgical risk (HSR) is unknown. Recently, the EVEREST II (Endovascular Valve Edgeto-Edge Repair) High Risk Study suggested MitraClip (MC) was a safe and effective treatment option. Methods: We performed a search strategy for MC or mitral valve surgery (MVS) in patients at HSR for surgical mortality (logistic EuroSCORE >18 or STS score > 10) using Medline databases, proceedings of international meetings, and the STS database. We identified 21 studies utilizing MC (n 5 3,198) and MVS (n 5 3,265, >90% from the STS database) from 2003 to 2013. Information about patient characteristics, surgical risk, and 30-day and 1-year outcomes were extracted. Results: Patients who underwent MC or MVS had a mean age of 74 6 10 years with no differences in surgical risk, NYHA class, or MR grade (P 5 0.46). Technical success was achieved in 96% of patients undergoing MC versus 98% in the MVS group (P 5 0.45). Patients undergoing MC were treated with one or two MC in 90% (n 5 2,878) with only a few requiring repeat MC (0.4%, n 5 13) or mitral surgery (0.3%, n 5 52) at 30 days. The pooled event rates for mortality was 3.2% (95% CI [2.5-4.2]), stroke was 1.1% (95% CI [0.7-0.2]) at 30 days. At 31 days to 1 year, the pooled event rate for mortality was 13.0% [95% CI (9-18.3)], stroke was 1.6% [95% CI (0.8-3.2)], and repeat MVS was 1.3% [95% CI (0.7-2.6)] with the majority of patients in the mild/moderate MR grade and NYHA class after MC. The 30-day event rates for mortality and stroke were 16.8% (95% CI [14][15][16][17][18][19]) and 4.5% (95% CI [3.9-5.3]) after MVS, respectively. Conclusion: Based on high risk MC studies and high risk MVS data predominantly from STS database, patients with severe MR who are at HSR can be effectively treated with MC or MVS. MC can be safely implanted in high risk patients with relatively low mortality and stroke risk. V C 2014 Wiley Periodicals, Inc.

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“…3) Hvass and colleagues 4) described a simple procedure, named the papillary muscle sling method, which created close contact with both papillary muscles using a Gore-Tex tube sling. Menicanti and colleagues 5) reported a papillary muscle imbrication procedure without a mitral ring.…”

Section: Discussionmentioning

confidence: 99%

Papillary Muscle Head Approximation for the Treatment of Mitral Valve Regurgitation Combined With Aortic Valve Disease

et al. 2010

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SummaryWe initiated an original papillary muscle head approximation procedure, commonly known as Sandwich plasty, for the treatment of ischemic mitral regurgitation (MR). In this study, we evaluated the appropriateness of this procedure for functional MR associated with aortic valve disease. Fifteen patients who had undergone Sandwich plasty combined with aortic valve surgery were included in this study. The mean age of the patients was 69 years. Predominant aortic valve diseases were regurgitation in 8 patients and stenosis in 7 patients. Aortic valve replacement was performed in 14 patients and David surgery in one. The mitral valve was approached through the aortic annulus in 9 patients (the transaortic group). Six other patients with mitral valve annulus of 30 mm or larger underwent concomitant mitral ring-annuloplasty through a left atrial incision (the LA group). The tenting height of the mitral valve and left ventricle diastolic diameter significantly decreased after surgery in both groups. After surgery, residual moderate or mild MR was detected in two patients in the transaortic group. In the LA group, residual mitral regurgitation was not detected. In the follow-up study, prominent MR occurred in two patients in the transaortic group. The MR free rate two years after surgery was 83% in the total patient population. Sandwich plasty was simple and effective in the treatment of functional mitral regurgitation combined with aortic valve surgery. A transaortic approach is effective in obviating a separate left atriotomy and reducing operation time. (Int Heart J 2010; 51: 47-50)

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Papillary muscle sling: a new functional approach to mitral repair in patients with ischemic left ventricular dysfunction and functional mitral regurgitation

Cited by 187 publications

References 3 publications

Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies

Mitral valve repair and subvalvular intervention for secondary mitral regurgitation: a systematic review and meta-analysis of randomized controlled and propensity matched studies

MitraClip for severe symptomatic mitral regurgitation in patients at high surgical risk

Papillary Muscle Head Approximation for the Treatment of Mitral Valve Regurgitation Combined With Aortic Valve Disease

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