title: Papillary muscle repositioning as a subvalvular apparatus preservation technique in mitral stenosis patients with normal left ventricular systolic function.
abstract: Subvalvular apparatus preservation is an important concept in mitral valve replacement (MVR) surgery that is performed to remedy mitral regurgitation. In this study, we sought to determine the effects of papillary muscle repositioning (PMR) on clinical outcomes and echocardiographic left ventricular function in rheumatic mitral stenosis patients who had normal left ventricular systolic function. We prospectively assigned 115 patients who were scheduled for MVR surgery with mechanical prosthesis to either PMR or MVR-only groups. Functional class and echocardiographic variables were evaluated at baseline and at early and late postoperative follow-up examinations. All values were compared between the 2 groups. The PMR group consisted of 48 patients and the MVR-only group of 67 patients. The 2 groups' baseline characteristics and surgery-related factors (including perioperative mortality) were similar. During the 18-month follow-up, all echocardiographic variables showed a consistent improvement in the PMR group; the mean left ventricular ejection fraction deteriorated significantly in the MVR-only group. Comparison during follow-up of the magnitude of longitudinal changes revealed that decreases in left ventricular end-diastolic and end-systolic diameters and in left ventricular sphericity indices, and increases in left ventricular ejection fractions, were significantly higher in the PMR group than in the MVR-only group. This study suggests that, in patients with rheumatic mitral stenosis and preserved left ventricular systolic function, the addition of papillary muscle repositioning to valve replacement with a mechanical prosthesis improves left ventricular dimensions, ejection fraction, and sphericity index at the 18-month follow-up with no substantial undesirable effect on the surgery-related factors.
authors: Departments of Cardiovascular Surgery (Drs. Kerim Cagli, Cicek, Diken, Gunertem, Lafci, and Yalcinkaya) and Cardiology (Drs. Kumral Cagli and Turak), Turkiye Yuksek Ihtisas Hospital, 06100 Ankara; Department of Cardiovascular Surgery (Dr. Korkmaz), Ankara Numune Education and Research Hospital, 06330 Ankara; and Department of Cardiovascular Surgery (Dr. Uzun), Ankara Education and Research Hospital, 06340 Ankara; Turkey.
authors: Gokhan
authors: G
authors: Lafci
authors: Kerim
authors: K
authors: Cagli
authors: Omer Faruk
authors: OF
authors: Cicek
authors: Kemal
authors: K
authors: Korkmaz
authors: Osman
authors: O
authors: Turak
authors: Alper
authors: A
authors: Uzun
authors: Adnan
authors: A
authors: Yalcinkaya
authors: Adem
authors: A
authors: Diken
authors: Eren
authors: E
authors: Gunertem
authors: Kumral
authors: K
authors: Cagli
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D010210:Papillary Muscles / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D020127:Recovery of Function; D012214:Rheumatic Heart Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D013318:Stroke Volume; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D016277:Ventricular Function, Left