Abstract 2982: Tethering Reduction Procedures for Restrictive Annuloplasty in Ischemic Mitral Regurgitation: Improved Anterior Mitral Leaflet Tethering Associated With More Effective Mid-Term Outcome in Patients With Advanced Left Ventricular Remodeling
Background: Although tethering reduction procedures (chordul cutting, papillary muscle approximation, papillary muscle elevation) on the subvalvular apparatus for restrictive annuloplasty in ischemic mitral regurgitation (MR) is known to reduce recurrent MR following surgical annuloplasty, morphological changes of leaflets are not fully investigated. We hypothesized that concomitant tethering reduction procedures to annuloplasty specifically attenuates AML tethering and contributes to reduced recurrence of ischemic MR. The purpose was to investigate the characteristics of mitral leaflet configurations and MR following surgical annuloplasty in patients with or without concomitant tethering reduction surgery.
Methods: In 30 consecutive patients with isolated MAP and 25 consecutive patients with concomitant tethering reduction procedures to MAP for IMR, variables of AML or posterior leaflet (PML) tethering (AML angle: α1, bending angle: β, PML angle: α2, AML excursion), and color Doppler MR jet width (vena contracta) were quantified by echocardiography 1.8±0.4 years after the surgery. Concomitant tethering reduction procedures was performed for patients with more advanced LV remodeling and ischemic MR by surgeon’s policy.
Compared to patients with isolated MAP, those with concomitant tethering reduction procedures had significantly greater LV dilatation in both pre- and post-operative stage (post-operative sphericity: 0.59±0.08 vs. 0.64±0.06, p<0.05) and post-operative PML tethering (α2: 95±13 vs. 103±9 degree, p<0.05).
In contrast, post-operative AML tethering was significantly less in patients with concomitant tethering reduction procedures (α1: 30±6 vs. 25±7 degree, p<0.01; β: 152±11 vs. 182±23 degree, p<0.0001, AML excursion: 29±13 vs. 38±15 degree, p<0.05).
While 9 of the 30 (30%) patients with isolated MAP developed recurrent ischemic MR, the recurrence was significantly less (2 of 25, 8%) in those with concomitant tethering reduction procedures to MAP (p<0.05).
Conclusion: It is suggested that concomitant subvalvular tethering reduction procedures for restrictive annuloplasty specifically attenuates AML tethering and reduce recurrent ischemic MR following surgical annuloplasty.