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Papillary muscle relocation and mitral annuloplasty in ischemic mitral valve regurgitation: midterm results.
J Thorac Cardiovasc Surg 2014; 148(5):1947-50JT

Abstract

OBJECTIVES

The surgical approach for ischemic mitral regurgitation remains unclear. Many studies are in favor of adding the subvalvular procedure to mitral annuloplasty to reduce recurrent mitral regurgitation. This study reports the clinical and echocardiographic outcomes of papillary muscle relocation combined with mitral annuloplasty.

METHODS

From 2003, 115 patients with severe ischemic mitral regurgitation who underwent papillary muscle relocation plus nonrestrictive mitral annuloplasty and coronary artery bypass grafting were retrospective analyzed. Patients' mean age was 52±12.8 years, New York Heart Association class III or IV was 71%, and preoperative left ventricular ejection fraction was 43%±6%. The study end points were New York Heart Association functional class, reversal in left ventricle remodeling, reduction of mean tenting area and mean coaptation depth, freedom from cardiac-related deaths and events, and freedom from recurrent mitral regurgitation. Follow-up data were obtained in all patients and were 100% complete. Mean follow-up was 45±6 months.

RESULTS

Five-year freedom from cardiac-related death and events was 91.3%±1.6% and 84%±2.2%, respectively. Recurrent mitral regurgitation more than moderate occurred in 3 patients (2.7%). Reversal in left ventricular remodeling, measured by a change in the end-diastolic and systolic diameter, was observed in our patients (P<.05). The postoperative mean tenting area and mean coaptation depth were 1.1±0.2 cm2 and 0.5±0.2 cm, respectively; 95% of the patients were in New York Heart Association functional class I and II.

CONCLUSIONS

In patients with ischemic mitral regurgitation, papillary muscle relocation plus nonrestrictive mitral annuloplasty promotes a significant reversal in left ventricular remodeling, with a considerable decrease in tenting area and coaptation depth. Our approach is a durable method to reduce the recurrence of mitral insufficiency.

Authors+Show Affiliations

Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy. Electronic address: khalilfattouch@hotmail.com.Department of Cardiac Surgery, University of Bologna, Bologna, Italy.Department of Cardiac Surgery, University of Bologna, Bologna, Italy.Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.Department of Cardiovascular Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy.Department of Cardiovascular Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24656671

Citation

Fattouch, Khalil, et al. "Papillary Muscle Relocation and Mitral Annuloplasty in Ischemic Mitral Valve Regurgitation: Midterm Results." The Journal of Thoracic and Cardiovascular Surgery, vol. 148, no. 5, 2014, pp. 1947-50.
Fattouch K, Castrovinci S, Murana G, et al. Papillary muscle relocation and mitral annuloplasty in ischemic mitral valve regurgitation: midterm results. J Thorac Cardiovasc Surg. 2014;148(5):1947-50.
Fattouch, K., Castrovinci, S., Murana, G., Dioguardi, P., Guccione, F., Nasso, G., & Speziale, G. (2014). Papillary muscle relocation and mitral annuloplasty in ischemic mitral valve regurgitation: midterm results. The Journal of Thoracic and Cardiovascular Surgery, 148(5), pp. 1947-50. doi:10.1016/j.jtcvs.2014.02.047.
Fattouch K, et al. Papillary Muscle Relocation and Mitral Annuloplasty in Ischemic Mitral Valve Regurgitation: Midterm Results. J Thorac Cardiovasc Surg. 2014;148(5):1947-50. PubMed PMID: 24656671.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Papillary muscle relocation and mitral annuloplasty in ischemic mitral valve regurgitation: midterm results. AU - Fattouch,Khalil, AU - Castrovinci,Sebastiano, AU - Murana,Giacomo, AU - Dioguardi,Pietro, AU - Guccione,Francesco, AU - Nasso,Giuseppe, AU - Speziale,Giuseppe, Y1 - 2014/02/20/ PY - 2013/05/01/received PY - 2014/01/26/revised PY - 2014/02/14/accepted PY - 2014/3/25/entrez PY - 2014/3/25/pubmed PY - 2015/2/11/medline SP - 1947 EP - 50 JF - The Journal of thoracic and cardiovascular surgery JO - J. Thorac. Cardiovasc. Surg. VL - 148 IS - 5 N2 - OBJECTIVES: The surgical approach for ischemic mitral regurgitation remains unclear. Many studies are in favor of adding the subvalvular procedure to mitral annuloplasty to reduce recurrent mitral regurgitation. This study reports the clinical and echocardiographic outcomes of papillary muscle relocation combined with mitral annuloplasty. METHODS: From 2003, 115 patients with severe ischemic mitral regurgitation who underwent papillary muscle relocation plus nonrestrictive mitral annuloplasty and coronary artery bypass grafting were retrospective analyzed. Patients' mean age was 52±12.8 years, New York Heart Association class III or IV was 71%, and preoperative left ventricular ejection fraction was 43%±6%. The study end points were New York Heart Association functional class, reversal in left ventricle remodeling, reduction of mean tenting area and mean coaptation depth, freedom from cardiac-related deaths and events, and freedom from recurrent mitral regurgitation. Follow-up data were obtained in all patients and were 100% complete. Mean follow-up was 45±6 months. RESULTS: Five-year freedom from cardiac-related death and events was 91.3%±1.6% and 84%±2.2%, respectively. Recurrent mitral regurgitation more than moderate occurred in 3 patients (2.7%). Reversal in left ventricular remodeling, measured by a change in the end-diastolic and systolic diameter, was observed in our patients (P<.05). The postoperative mean tenting area and mean coaptation depth were 1.1±0.2 cm2 and 0.5±0.2 cm, respectively; 95% of the patients were in New York Heart Association functional class I and II. CONCLUSIONS: In patients with ischemic mitral regurgitation, papillary muscle relocation plus nonrestrictive mitral annuloplasty promotes a significant reversal in left ventricular remodeling, with a considerable decrease in tenting area and coaptation depth. Our approach is a durable method to reduce the recurrence of mitral insufficiency. SN - 1097-685X UR - https://www.unboundmedicine.com/medline/citation/24656671/Papillary_muscle_relocation_and_mitral_annuloplasty_in_ischemic_mitral_valve_regurgitation:_midterm_results_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-5223(14)00207-4 DB - PRIME DP - Unbound Medicine ER -