Papillary muscle repositioning in valve replacement for left ventricular dysfunction: ischemic mitral regurgitation.
BACKGROUND
The aim of this study was to investigate the feasibility of performing papillary muscle repositioning (PMR) for subvalvular-sparing mitral valve replacement procedures in patients with ischemic mitral regurgitation and to determine the early and late effects of this procedure on the clinical outcome and left ventricular mechanics.


METHODS
We prospectively randomly allocated 50 patients with severe ischemic mitral regurgitation and left ventricle dysfunction who were candidates for coronary artery bypass graft surgery and mitral valve replacement into a total chordal-sparing mitral valve replacement group or a PMR group. Echocardiography was performed preoperatively, at discharge, and after 3 years to determine the left ventricular dimensions, shape, and function.


RESULTS
The reduction in the left ventricle volumes and sphericity index in the PMR group was more significant than that in the other group. With regard to the left ventricular end-systolic and left ventricular end-diastolic volumes, sphericity index, and ejection fraction, the PMR group showed better results (p < 0.05), but the difference in New York Heart Association functional class after 3 years was not statistically significant between the two groups (p > 0.05).


CONCLUSIONS
The PMR technique described herein can dramatically help ischemic patients by affecting the left ventricular shape and function more efficiently compared with the complete retention of the mitral subvalvular apparatus if the mitral valve is to be replaced.
Yousefnia
Mohammad Ali
MA
Day General Hospital, Tehran, Iran.
Dehestani
Alireza
A
Saidi
Bahare
B
Roshanali
Farideh
F
Mandegar
Mohammad Hossein
MH
Alaeddini
Farshid
F
D006348:Cardiac Surgical Procedures / Q000379:methods; D005240:Feasibility Studies; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications; D010210:Papillary Muscles / Q000601:surgery*; D011446:Prospective Studies; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000601:surgery*