Surgical strategy for ischemic mitral regurgitation adopting subvalvular and ventricular procedures

Annals of Thoracic and Cardiovascular Surgery : Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
Satoru WakasaYoshiro Matsui

Abstract

The progression of left ventricular (LV) remodeling and subsequent mitral valve tethering impair the results of reduction annuloplasty for ischemic mitral regurgitation (MR). We studied 90 patients who underwent surgical repair of ischemic MR between 1999 and 2013 according to our surgical strategy adding submitral and ventricular procedures to annuloplasty as follows: annuloplasty alone (stage 1, n = 30), additional papillary muscle approximation (PMA) for progression of tethering (stage 2, n = 26), and additional left ventriculoplasty with PMA for progression of LV remodeling and tethering (stage 3, n = 34). The preoperative New York Heart Association (NYHA) functional classes (2.5 ± 0.7, 3.1 ± 0.7 and 3.3 ± 0.7 for stages 1, 2 and 3, respectively, P <0.001), LV end-diastolic diameters (56 ± 7 mm, 66 ± 5 mm and 70 ± 7 mm, P <0.001), and LV ejection fractions (45 ± 12%, 32 ± 9% and 27 ± 9%, P <0.001) significantly differed among the stages. In contrast, the MR grades did not significantly differ (2.9 ± 0.8, 3.0 ± 1.0, and 2.9 ± 1.1, respectively; P = 0.93). Both the rates of cardiac-related survival and freedom from reoperation were comparable among the 3 groups (log-rank P = 0.92 and 0.58, respectively). Additional submitral ...Continue Reading

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Citations

May 21, 2016·Journal of the American College of Cardiology·Francesco NappiMassimo Chello
Jun 24, 2017·Interactive Cardiovascular and Thoracic Surgery·Leonidas V AthanasopoulosThanos Athanasiou
Mar 15, 2018·Heart·Eva Karolina HarmelEvaldas Girdauskas
Apr 22, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Jonas PauschEvaldas Girdauskas
Aug 16, 2016·European Heart Journal Cardiovascular Imaging·Olivier VillemainEmmanuel Messas
Jan 18, 2020·Journal of Cardiac Surgery·Linda R MicaliSandro Gelsomino
Mar 12, 2020·Journal of Cardiac Surgery·Massimo MecoMattia Glauber
Jan 4, 2017·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Christos G MihosOrlando Santana
Sep 20, 2019·European Journal of Cardio-thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery·Annelieke H J PetrusJerry Braun

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