[en] OBJECTIVE: the incidence of recurrent mitral regurgitation (MR) after restrictive annuloplasty (RA) was 5% to 20% in several reports. There are many opinions in favor of adding subvalvular procedures to RA to reduce the tenting forces and improve the repair results.
METHODS: From March 2003 to May 2010, 55 patients with severe ischemic MR who had undergone papillary muscle (PPM) relocation in conjunction with mitral annuloplasty in our institutions were enrolled. The patients were matched 1:1 with those who underwent isolated RA using the propensity score. The mean left ventricular ejection fraction was 42% ± 6%. The mean tenting area and coaptation depth was 3.2 ± 0.6 cm(2) and 1.3 ± 0.2 cm, respectively. The study endpoints were early mortality and clinical and echocardiographic outcomes, freedom from cardiac-related deaths, and cardiac-related events.
RESULTS: In-hospital death occurred in 5 patients (4.5%), without a statistically significant difference between the 2 groups (P = .72). The 5-year freedom from cardiac-related deaths and cardiac-related events in the PPM relocation group versus the RA group was 90.9% ± 1.8% versus 89% ± 1.6% (P = .82) and 83% ± 2.1% versus 65.4% ± 1.2% (P < .001), respectively. Recurrent MR equal to or greater than moderate occurred in 2 (3.7%) and 6 (11.5%) patients in the PPM relocation group and RA group (P = .01), respectively. Moreover, we found statistically significant differences for the postoperative mean tenting area and coaptation depth in both groups (P < .001).
CONCLUSIONS: PPM relocation in conjunction to mitral annuloplasty is an easy and safe method and can be performed without an increase in-hospital mortality. This technique reduced the tenting area and coaptation depth compared with isolated RA, leading to improvement in the incidence of recurrent MR. The PPM group of patients experienced fewer cardiac-related events.
Research center :
Service de Cardiologie
Disciplines :
General & internal medicine
Author, co-author :
Fattouch, K.
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Imagerie cardiaque fonctionnelle par échographie
Castrovinci, S.
Murana, G.
Sampognaro, R.
Corrado, E.
Caruso, M.
Speziale, G.
Novo, S.
Ruvolo, G.
Language :
English
Title :
Papillary muscle relocation in conjunction with valve annuloplasty improve repair results in severe ischemic mitral regurgitation.
R.O. Bonow, B.A. Carabello, and K. Chatterjee American College of Cardiology/American Heart Association Task Force on Practice Guidelines. ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease JACC 48 2006 1 148
S.F. Bolling, G.M. Deeb, L.A. Brunsting, and D.S. Bach Early outcome of mitral valve reconstruction in patients with end-stage cardiomyopathy J Thorac Cardiovasc Surg 109 1995 676 682
K. Fattouch, F. Guccione, and R. Sampognaro Efficacy of adding mitral valve restrictive annuloplasty to CABG in patients with moderate ischemic mitral valve regurgitation: a randomised trial J Thorac Cardiovasc Surg 138 2009 278 285
A.M. Gillinov, P.N. Wierup, and E.H. Blackstone Is repair preferable to replacement for ischemic mitral regurgitation? J Thorac Cardiovasc Surg 122 2001 1125 1141 (Pubitemid 35470910)
D.H. Adams, R.H. Chen, and J.G. Byrne Improving outcomes in patients with moderate ischemic mitral regurgitation undergoing combined CABG and mitral annuloplasty Circulation 102 Suppl II 2000 II-462
C.M. Vassileva, T. Boley, S. Markwell, and S. Hazelrigg Meta-analysis of short-term and long-term survival following repair versus replacement for ischemic mitral regurgitation Eur J Cardiothoracic Surg 39 2011 295 303
J.J. Bax, J. Braun, and S.T. Somer Restrictive annuloplasty and coronary revascularization in ischemic mitral regurgitation results in reverse left ventricular remodeling Circulation 110 Suppl II 2004 II-103 II-108
E. Kuwahara, Y. Otsuji, and Y. Iguro Mechanism of recurrent/persistent ischemic/functional mitral regurgitation in chronic phase after surgical annuloplasty: importance of augmented posterior leaflet tethering Circulation 114 2006 I-529 I-534
T. Mihalijevic, B.K. Lam, and J. Rajeswaran Impact of mitral valve annuloplasty combined with revascularization in patients with functional ischemic mitral regurgitation JACC 49 2007 2191 2201 (Pubitemid 46817809)
I.L. Kron, G. Randall Green, and J.T. Cope Surgical relocation of the posterior papillary muscle in chronic ischemic mitral regurgitation Ann Thorac Surg 74 2002 600 601 (Pubitemid 34836988)