TY - JOUR
T1 - Papillary muscle relocation and mitral annuloplasty in ischemic mitral valve regurgitation: Midterm results
AU - Fattouch, Khalil
AU - Guccione, Francesco
AU - Dioguardi, Pietro
AU - Castrovinci, Sebastiano
AU - Murana, Giacomo
AU - Nasso, Giuseppe
AU - Fattouch, Khalil
AU - Speziale, Giuseppe
AU - Guccione, Francesco
AU - Dioguardi, Pietro
PY - 2014
Y1 - 2014
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.
AB - 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.
KW - Adult; Disease-Free Survival; Female; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Myocardial Ischemia; Papillary Muscles; Postoperative Complications; Recurrence; Risk Factors; Severity of Illness Index; Time Factors; Treatment Ou
KW - Left; Ventricular Remodeling; Mitral Valve Annuloplasty; Cardiology and Cardiovascular Medicine; Surgery; Pulmonary and Respiratory Medicine; Medicine (all)
KW - Adult; Disease-Free Survival; Female; Humans; Male; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Myocardial Ischemia; Papillary Muscles; Postoperative Complications; Recurrence; Risk Factors; Severity of Illness Index; Time Factors; Treatment Ou
KW - Left; Ventricular Remodeling; Mitral Valve Annuloplasty; Cardiology and Cardiovascular Medicine; Surgery; Pulmonary and Respiratory Medicine; Medicine (all)
UR - http://hdl.handle.net/10447/212086
UR - http://www.elsevier.com/inca/publications/store/6/2/3/1/5/1/index.htt
M3 - Article
VL - 148
SP - 1947
EP - 1950
JO - Journal of Thoracic and Cardiovascular Surgery
JF - Journal of Thoracic and Cardiovascular Surgery
SN - 0022-5223
ER -