Abstract 15036: Papillary Muscle Sling and Mitral Valve Repair for Secondary Mitral Regurgitation: The SLING Study
Background: There is a 30-60% incidence of recurrent mitral regurgitation after mitral valve annuloplasty (Ring) for secondary mitral regurgitation (MR). A concomitant papillary muscle sling (Ring+Sling) may improve valve repair by promoting a more physiologic geometry of the mitral apparatus.
Methods: We retrospectively identified 58 consecutive patients with moderate to severe secondary MR that underwent a Ring+Sling repair, between March 2008 and May 2015. A Ring+Sling consisted of combined annuloplasty and papillary muscle approximation, utilizing a 4-mm polytetrafluoroethylene graft placed around the base of each muscle (Figures A and B). Comparison of echocardiographic variables with patients who underwent a Ring only was performed utilizing 2:1 propensity-score matching (Ring+Sling=34; Ring=17).
Results: The baseline demographics were similar between the groups. The mean time to follow-up echocardiogram was 10.1 months (range 0.25-42 months). At follow-up, a Ring+Sling repair was associated with a lower mitral valve tenting height (p=0.005), mitral valve tenting area (p=0.009), and interpapillary muscle distance (p=0.001), a smaller posterior leaflet tethering angle (p=0.003), and a greater leaflet coaptation length (p=0.002), when compared with Ring only. Recurrence of moderate or greater MR occurred significantly less in the Ring+Sling group (14.7%), as compared with Ring only (35.3%) (p<0.001). Finally, actuarial survival at 3 years was 87% for Ring+Sling, and 82% for Ring only.
Conclusions: A Ring+Sling for secondary MR results in favorable changes in the mitral valve apparatus geometry, and is associated with less MR recurrence in the early post-operative period. Longer-term follow-up is needed to assess its durability and effects on left ventricular remodeling.
Author Disclosures: C.G. Mihos: None. R. Capoulade: None. E. Yucel: None. S. Melnitchouk: None. J. Hung: None.
- © 2016 by American Heart Association, Inc.