scholarly journals Mid-term results of papillary muscles approximation: a retrospective single-center study

2018 ◽  
Vol 22 (4) ◽  
pp. 54
Author(s):  
V. V. Bazylev ◽  
A. I. Mikulyak ◽  
R. M. Babukov ◽  
V. A. Karnakhin
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Ischemic Cardiomyopathy ◽  
Left Ventricular ◽  
Rank Test ◽  
Mitral Insufficiency ◽  
Papillary Muscles ◽  
Mitral Annuloplasty ◽  
Mid Term Results

<p><strong>Background.</strong> Enlargement of the left ventricular chamber and displacement of papillary muscles in the apical and lateral directions increase the tethering forces. Left ventricular and papillary muscle desynchrony and reduced myocardial contractility reduce the closing forces, thus leading to impaired leaflet coaptation and appearance of mitral regurgitation. Therefore, treatment of mitral insufficiency requires an integrated approach, affecting all aspects of the pathogenesis of mitral regurgitation recurrence. Recent publications show that adjunctive subvalvular repair during mitral annuloplasty for secondary mitral regurgitation is effective in preventing recurrent regurgitation. One of these procedures is papillary muscle approximation. However, the safety and the positive impact of this method are still open to question. <br /><strong>Aim.</strong> This study focused on the assessment of mid-term results of papillary muscles approximation and comparison of the obtained results with those of isolated mitral annuloplasty.<br /><strong>Methods.</strong> Two hundred and twelve patients with ischemic cardiomyopathy and ischemic mitral regurgitation were enrolled in this retrospective single-center study. The patients were randomised to 2 groups by using propensity score matching (a “neighbor” method) according to the following parameters: end diastolic volume, end systolic volume, stroke volume and ejection fraction. The first group included 112 patients with ischemic cardiomyopathy and mitral regurgitation, who underwent coronary artery bypass grafting, mitral annuloplasty and papillary muscle approximation. The second group included 112 patients with ischemic cardiomyopathy who underwent coronary artery bypass grafting and mitral valve annuloplasty. We evaluated early and mid-term results.<br /><strong>Results.</strong> Two patients in group 1 and three patients in group 2 died of heart failure progression during 31.3±10.4 month follow-up. According to the Kaplan-Meier analysis, no statistically significant differences were noted between the groups (log-rank test = 0.8). Approximation of papillary muscles in patients with ischemic mitral regurgitation improved mitral valve leaflet coaptation as evidenced by the values of coaptation depth, coaptation line and tenting area (p&gt;0.05). During follow-up, 3 cases (2.7%) of mitral insufficiency recurrence were recorded in group 1 and 16 (14.3%) in group 2. The Kaplan-Meier analysis of cumulative probability showed a significant difference in freedom from recurrence of mitral regurgitation ≥2 between groups in the mid-term postoperative period (log-rank test = 0.041).<br /><strong>Conclusion.</strong> Adjunctive papillary muscle approximation performed at the time of mitral annuloplasty improves the durability of mitral valve repair.</p><p>Received 18 April 2018. Revised 12 October 2018. Accepted 18 October 2018.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

scholarly journals Exploring the Operative Strategy for Secondary Mitral Regurgitation: A Systematic Review

2021 ◽  
Vol 2021 ◽  
pp. 1-22
Author(s):  
Francesco Nappi ◽  
Sanjeet Singh Avtaar Singh ◽  
Francesca Bellomo ◽  
Pierluigi Nappi ◽  
Camilla Chello ◽  
...  
Keyword(s):  
Systematic Review ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Papillary Muscle ◽  
Left Ventricular ◽  
Cochrane Library ◽  
Heart Team ◽  
Mitral Annuloplasty ◽  
Observational Series ◽  
Secondary Mitral Regurgitation

Background. Mitral valve disease surgery is an evolving field with multiple possible interventions. There is an increasing body of evidence regarding the optimal strategy in secondary mitral regurgitation where the pathology lies within the ventricle. We conducted a systematic review to identify the benefits and limitations of each surgical option. Methods. A systematic review of the literature was performed to identify pertinent randomized controlled trials (RCTs), propensity-matched observational series, and meta-analyses which were considered initially and followed by unmatched observational series using the MEDLINE, Ovid EMBASE, and Cochrane Library. Results. We identified 6 different strategies for treating secondary mitral valve regurgitation: mitral valve replacement, restrictive mitral annuloplasty, surgical revascularization (with and without mitral annuloplasty), subvalvular procedures (papillary muscle approximation, papillary muscle relocation, ring and string procedure), and procedures directly targeting the mitral valve (edge-to-edge repair and anterior leaflet enlargement) alongside transcatheter heart valve therapy. We also highlighted the role of left ventricular assist devices in the management of this condition. The benefits and limitations of each intervention are highlighted. Conclusion. There is currently no unanimous and shared strategy for the optimal treatment of patients with secondary IMR. The management of patients with secondary mitral regurgitation must be entrusted to a multidisciplinary Heart Team to ensure ideal intervention and patient matching for the best outcomes.

Abstract 2262: No Impact Of The Mitral Annuloplasty On Overall Survival In Patients With Ischemic Cardiomyopathy - Long-term Follow-up Study.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Krzysztof S Golba ◽  
Jolanta Biernat ◽  
Marek A Deja ◽  
Wojciech Domaradzki ◽  
Marek Jasiński ◽  
...  
Keyword(s):  
Overall Survival ◽  
Mitral Regurgitation ◽  
Ischemic Cardiomyopathy ◽  
Cox Regression ◽  
Coronary Bypass ◽  
Left Ventricular ◽  
Long Term Results ◽  
Mitral Annuloplasty ◽  
Cox Regression Analysis

Good long-term results are reported after the mitral valve (MV) repair for ischemic regurgitation. The aim of the study was to identify predictors of the overall survival after routine MV repair in patients with ischemic cardiomyopathy. Methods. 164 patients, 60.9±8.66 years old, with chronic ischemic mitral regurgitation and left ventricle ejection fraction (EF) = 30.7±6.04 undergoing coronary bypass with or without MV repair were prospectively followed for 5.1±1.63 years. A Cox proportional hazards model evaluated overall survival as a function of baseline age, sex, EF, mitral regurgitation jet area, left atrial area, atrial fibrillation, NYHA class, prior anterior or inferior myocardial infarction, medical comorbidities, MV repair, left ventricular plasty, left main and 3 vessel disease, venous graft to left anterior descending artery, number of grafts and year of operation. Treatment selection bias was controlled by deriving a propensity score for mitral annuloplasty. Results. Predictors included in the Cox regression model of overall survival are presented in table . The ROC curve analysis revealed EF <30.0, (sensitivity and specificity - 61.7% and 59.0%, respectively) and serum creatinine >1.17, (45.6% and 77.2%) as a cut-off values in the prediction of overall survival. Conclusions. There is no impact of the mitral annuloplasty on overall survival in these patients. MV repair can be safely added to coronary bypass grafting in patients with ischemic cardiomyopathy. Multivariable Cox regression analysis results

Systolic Papillary Muscle Dyssynchrony Predicts Recurrence of Mitral Regurgitation in Patients with Ischemic Cardiomyopathy (ICM) Undergoing Mitral Valve Repair

2012 ◽  
Vol 29 (10) ◽  
pp. 1191-1200 ◽  
Author(s):  
Leen van Garsse ◽  
Sandro Gelsomino ◽  
Orlando Parise ◽  
Fabiana Lucà ◽  
Emile Cheriex ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Mitral Valve Repair ◽  
Papillary Muscle ◽  
Ischemic Cardiomyopathy ◽  
Valve Repair

scholarly journals P1720 Hammock mitral valve, a challenging echocardiographic diagnosis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Rodrigo Carbonero ◽  
U Estandia ◽  
C Perez ◽  
R Voces ◽  
P Perez ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Papillary Muscle ◽  
Tricuspid Regurgitation ◽  
Pulmonary Veins ◽  
Left Ventricular ◽  
Valve Disease ◽  
Valve Prosthesis ◽  
Papillary Muscles ◽  
Rheumatic Valve Disease

Abstract We report a 43 year-old female with a past TTE echocardiography of rheumatic valve disease performed in her district hospital , ( No clear symptomatology of rheumatic fever in the past). She was transferred to our tertiary hospital for elective cardiac surgery. Preoperative echocardiogram showed a non-dilated left ventricle with preserved contractility, mild-moderate left atrium enlargement with severe mitral regurgitation and basal displacement of papillary muscles and severe tricuspid regurgitation.All of it resembling a hammock mitral valve instead of former echocardiogram described as rheumatic valve disease. Preoperative cardiac study showed severe pulmonary hypertension with increased pulmonary vascular resistances. Preserved biventricular cardiac output and increased proto and telesystolic pressures. During surgery , ifindings were described as a mitral valve with a large papillary muscle inserted in the distal third of the left ventricle with none tendinous cords at the anterior leaflet and without cords in the posterior leaflet with an isolated papillary muscle with cords at A3 and P3 scallops, compatible with hammock mitral valve. A tendinous muscle/fibrous or fibromuscular band connecting the septum to the posterior wall of the left ventricle was described. Moreover over, there was an enlarged tricuspid ring with very short tendinous cords on the septal leaflet, although the leaflet was bigger than usual. Surgery consisted of resection of the mitral valve preserving A3 and P3 scallops with a 29mm Bicarbon Sorin mechanical mitral prosthesis and a 32mm Carpentier tricuspid ring implantation and pulmonary veins ablation combined with occlusion of left atrial appendage. After 112 minutes of cross-clamping time, the patient was weaned from cardiopulmonary bypass. She had important left ventricle dysfunction which improved with dobutamine and AAI pacemaker at 90lpm. Postoperative TEE showed moderate dysfunction of right ventricle, mild left ventricular dysfunction, moderate tricuspid regurgitation and a good functioning of the prosthesis. TTE before discharge showed good function of mitral valve prosthesis, good left ventricle function, mild tricuspid regurgitation, mild-moderate right ventricular enlargement, although less than preoperatively. Conclusion Congenital mitral valulophaty is a rare condition in the adulthood. The estimated prevalence is 0,5%. The hammock mitral valve is a more uncommon pathology which affects the mitral valve and subvalvular apparatus. This anomaly, was first described in 1967 and it is characterised by anomalous papillary muscles directly connected to the anterior mitral valve by a fibrous bridge without chordae tendineae in between them. This fibrous bridge hampers the opening and closure of the mitral valve. Diagnosis requires a high index of suspicion, both ultrasound studies and medical history, to avoid misdiagnosis. Abstract P1720 Figure.

Sign in / Sign up

Export Citation Format

Share Document