Abstract 15293: Impact of Novel Mitral Valve Repair “Papillary Head Optimization” on Functional Mitral Regurgitation Compared With Conventional Annuloplasty
Background: Although down-sizing annuloplasty is widely accepted as a surgical treatment for functional mitral regurgitation (MR), the problems such as residual or recurrent MR and postoperative functional mitral stenosis remain unresolved. To avoid these problems, a technique known as “papillary head optimization (PHO)” has been developed, wherein for each papillary muscle, the heads which support anterior leaflet and posterior leaflet are connected together and then after mitral annuloplasty (MAP), the heads are relocated towards mid-anterior annulus by suturing. In this study, we investigated leaflet configurations after PHO, compared with down-sizing mitral annuloplasty (MAP) alone and tried to clarify the impact of this procedure on functional MR.
Methods: Twenty-two patients who underwent PHO and twenty patients who underwent down-sizing MAP were studied. Transthoracic echocardiography was performed before and 1-2 weeks after the operation. As an index of leaflet tethering, the angles between the annular plane and each leaflet were measured during systole and diastole.
Results: MR grade and anterior leaflet angle in systole significantly decreased in both groups postoperatively. The posterior leaflet angle in systole changed from 71±12 to 61±25 degrees with PHO (p=NS), while it showed a significant increase from 78±13 to 107±19 degrees with MAP (p<0.001). The anterior leaflet angle in diastole was significantly larger after the surgery in the PHO group compared to MAP group (65±13 degrees for PHO vs. 57 ±10 degrees for MAP, p<0.05).
Conclusion: Compared with MAP alone, PHO effectively controlled MR by reducing systolic tethering of the posterior leaflet and diastolic tethering of the anterior leaflet. This method may be effective for avoiding residual MR and postoperative mitral stenosis, though long-term follow-up is needed.
- © 2013 by American Heart Association, Inc.