Bilateral papillary muscle repositioning: successful repair of functional mitral regurgitation in dilative cardiomyopathy.

European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery
Frank LangerH-J Schäfers

Abstract

Functional mitral regurgitation (FMR) in patients with non-ischaemic dilative cardiomyopathy (DCM) is associated with heart failure and poor outcome. Aggressively undersized annuloplasty as an annular solution for a ventricular problem ameliorates heart failure but may be associated with recurrent FMR and does not improve survival. We sought to analyse if moderately undersized annuloplasty with repositioning of both papillary muscles can lead to improved valve stability and outcome in patients with DCM and FMR. In 66 patients with DCM-associated FMR (age 66 ± 12 years, ejection fraction 29 ± 6% and mean pulmonary artery pressure 35 ± 11 mmHg) and severe leaflet tethering (tenting height ≥10 mm) bilateral papillary muscle repositioning was added to moderately undersized ring annuloplasty (median size 30 mm). Concomitant surgery included tricuspid valve repair in 86% of patients and atrial ablation in 44%. The early mortality rate was 9%. Overall 5-year freedom from all-cause death, left ventricular assist device implantation or heart transplant was 58% (95% confidence interval 45-71%). Six patients underwent reoperation (redo repair n = 4). Reverse remodelling was observed during follow-up in 66% of patients with decreasing left...Continue Reading

References

Apr 1, 1995·The Journal of Thoracic and Cardiovascular Surgery·S F BollingD S Bach
Jun 3, 2004·The Annals of Thoracic Surgery·Antonio M CalafioreIsabella Tavarozzi
Apr 26, 2005·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Jerry BraunRobert A E Dion
Jan 3, 2007·The Journal of Thoracic and Cardiovascular Surgery·Frank Langer, Hans-Joachim Schäfers
Jul 21, 2010·The American Journal of Cardiology·Agnieszka CiarkaNico Van de Veire
Aug 28, 2012·The Journal of Thoracic and Cardiovascular Surgery·Michael H KwonFrederick Y Chen
Nov 20, 2013·The New England Journal of Medicine·Michael A AckerUNKNOWN CTSN
Aug 28, 2018·The New England Journal of Medicine·Jean-François ObadiaUNKNOWN MITRA-FR Investigators
Oct 4, 2018·The New England Journal of Medicine·Gregg W StoneUNKNOWN COAPT Investigators
Apr 1, 2019·Clinical Research in Cardiology : Official Journal of the German Cardiac Society·Torsten DoenstGloria Faerber

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