title: The role of papillary muscle approximation in mitral valve repair for the treatment of secondary mitral regurgitation.
abstract: Secondary mitral regurgitation (MR) is present in up to half of patients with dilated cardiomyopathy, and is associated with a poor prognosis. It primarily results from progressive left ventricular remodelling, papillary muscle displacement and tethering of the mitral valve leaflets. Mitral valve repair with an undersized ring annuloplasty is the reparative procedure of choice in the treatment of secondary MR. However, this technique is associated with a 30-60% incidence of recurrent moderate or greater MR at mid-term follow-up, which results in progressive deterioration of left ventricular function and increased morbidity. Combined mitral valve repair and papillary muscle approximation has been applied in order to address both the annular and subvalvular dysfunction that coexist in secondary MR, which include graft and suture-based techniques. Herein, we provide a systematic review of the published literature regarding the technical aspects, clinical application, and outcomes of mitral valve repair with combined ring annuloplasty and papillary muscle approximation for the treatment of secondary MR.
authors.affiliation: Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.affiliation: Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Evin
authors.initials: E
authors.lastname: Yucel
authors.affiliation: The Division of Cardiology at Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA.
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
mesh_terms: D000368:Aged; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D010210:Papillary Muscles / Q000601:surgery*; D012086:Reoperation
keywords: Functional mitral regurgitation ; Ischaemic mitral regurgitation ; Mitral valve repair ; Papillary muscle approximation ; Secondary mitral regurgitation