title: The role of papillary muscle relocation in ischemic mitral valve regurgitation.
abstract: Aim of our study was to compare the results of combined approach papillary muscles relocation (PPMr) + mitral annuloplasty (MA) vs only restrictive annuloplasty (RA) in ischemic mitral regurgitation, guided by 3-dimensional (3D) echocardiography. Sixty-nine patients with severe ischemic mitral regurgitation who had PPMr + MA and coronary artery bypass grafting were matched 1:1 with patients who underwent isolated RA and coronary artery bypass grafting. A comprehensive pre- and postoperatory 2-dimensional and 3D transesophageal echocardiographic examination followed by a 3D offline assessment of the mitral valve apparatus was performed. Five-year freedom from cardiac-related event in the PPMr + MA group and isolated RA group was 83% ± 2.1% and 65.4% ± 1.2%, respectively (P < 0.001). Recurrent mitral regurgitation equal to or greater than moderate occurred in 2 (2.8%) and 8 (11.5%) in PPMr + MA group and RA group, respectively (P < 0.02). The PPMr promoted a significant reversal in left ventricle remodeling compared with the isolated RA. PPMr + MA reduce the tenting area and the coaptation depth with respect to RA, with less incidence of recurrent mitral regurgitation.
authors: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy. khalilfattouch@hotmail.com
authors: Khalil
authors: K
authors: Fattouch
authors: Giacomo
authors: G
authors: Murana
authors: Sebastiano
authors: S
authors: Castrovinci
authors: Giuseppe
authors: G
authors: Nasso
authors: Giuseppe
authors: G
authors: Speziale
mesh_terms: D000368:Aged; D000818:Animals; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000601:surgery; D010210:Papillary Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D020257:Ventricular Remodeling