Papillary Muscle Repositioning in Valve Replacement for Left Ventricular Dysfunction: Ischemic Mitral Regurgitation

摘要

Surgical TechniqueEchocardiographic StudiesStatistical AnalysisResultsThe 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 and to determine the early and late effects of this procedure on the clinical outcome and left ventricular mechanics.MethodsWe prospectively randomly allocated 50 patients with severe ischemic mitral regurgitation and left ventricle dysfunction who were candidates for coronary artery bypass graft surgery and mitral valve replacement into a total chordal-sparing mitral valve replacement group or a PMR group. Echocardiography was performed preoperatively, at discharge, and after 3 years to determine the left ventricular dimensions, shape, and function.ResultsThe reduction in the left ventricle volumes and sphericity index in the PMR group was more significant than that in the other group. With regard to the left ventricular end-systolic and left ventricular end-diastolic volumes, sphericity index, and ejection fraction, the PMR group showed better results (p 0.05).ConclusionsThe PMR technique described herein can dramatically help ischemic patients by affecting the left ventricular shape and function more efficiently compared with the complete retention of the mitral subvalvular apparatus if the mitral valve is to be replaced.CTSNet classification:35The myocardium experiences remodeling in the wake of myocardial infarction: the ventricle dilates and the papillary muscles become displaced and, thus, ischemic mitral regurgitation (IMR) occurs [