Abstract 3965: Papillary Muscle Repositioning in Valve Replacement for Left Ventricualr Dysfunction: Ischemic Mitral Regurgitation
Objective: The aim of this study was to investigate the feasibility of performing papillary muscle repositioning (PMR) for subvalvular-sparing mitral valve replacement procedures in patients with ischemic mitral regurgitation (MR) and to determine the early and late effects of this procedure on the clinical outcome and left ventricular mechanics.
Methods: We prospectively randomized 50 patients with severe MR who were candidates for coronary artery bypass surgery (not suitable for annuloplasty) into total chordal-sparing mitral valve replacement (CMVR) and papillary muscle repositioning (PMR) groups for the surgical correction of mitral insufficiency. Echocardiography was performed pre-operatively, at discharge, and after three years to determine the dimensions, left ventricular shape, and function.
Results: The decrease in the left ventricular volumes and the sphericity index was more significant in the PMR group. With respect to the systolic performance, the ejection fraction had a significant increase in the PMR group (P-value <0.05). New York Heart Association classification was also significantly better in the PMR group (P-value <0.05).
Conclusion: When mitral valve replacement is inevitable, the PMR technique described herein by comparison with the complete retention of the mitral subvalvular apparatus could result in a more significant improvement in the outcome in ischemic patients, especially in terms of the left ventricle shape and function.