title: Papillary muscle relocation and mitral annuloplasty in ischemic mitral valve regurgitation: midterm results.
abstract: OBJECTIVE
  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.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy. Electronic address: khalilfattouch@hotmail.com.
authors.forename: Khalil
authors.initials: K
authors.lastname: Fattouch
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Bologna, Italy.
authors.forename: Sebastiano
authors.initials: S
authors.lastname: Castrovinci
authors.affiliation: Department of Cardiac Surgery, University of Bologna, Bologna, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Murana
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Dioguardi
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Maria Eleonora Hospital, Palermo, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Guccione
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nasso
authors.affiliation: Department of Cardiovascular Surgery, GVM Care and Research, Anthea Hospital, Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Speziale
mesh_terms: D000328:Adult; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D008944:Mitral Valve Insufficiency / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D017202:Myocardial Ischemia / Q000150:complications* / Q000401:mortality; D010210:Papillary Muscles / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling