title: Targeting the Papillary Muscles in Mitral Valve Repair for Ischemic Mitral Regurgitation.
abstract: Ischemic mitral regurgitation due to left ventricular remodeling and leaflet tethering is associated with decreased survival, and the optimal management remains unknown. Restrictive mitral annuloplasty is the current treatment of choice, but it is associated with a 15% to 30% incidence of late recurrent mitral regurgitation, which confers a poor prognosis. A pathophysiology-guided approach to surgical repair is preferable, with a goal of alleviating leaflet tethering and restoring proper subvalvular mechanics. In patients with preoperative predictors of annuloplasty failure, combining a papillary muscle repositioning technique with conventional annuloplasty repair allows for complete geometric repair of the ventriculomitral unit.
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.forename: Andres M
authors.initials: AM
authors.lastname: Pineda
authors.affiliation: Columbia University Division of Cardiology at Mount Sinai Heart Institute, Miami Beach, FL.
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana