Key result
Papillary muscle intervention plus annuloplasty reduces MR recurrence vs annuloplasty alone despite <10% LVRR.
Why the study?
Papillary muscle intervention combined with mitral ring annuloplasty was introduced to correct papillary muscle displacement and reduce recurrence in chronic ischemic mitral regurgitation, but comparative evidence was needed.
Does papillary muscle intervention combined with mitral ring annuloplasty reduce MR recurrence and improve left ventricular reverse remodeling in patients with chronic ischemic mitral regurgitation?
Meta-Analysis
Does papillary muscle intervention combined with mitral ring annuloplasty reduce MR recurrence and improve left ventricular reverse remodeling in patients with chronic ischemic mitral regurgitation?
Combining papillary muscle intervention with mitral ring annuloplasty reduces mitral regurgitation recurrence compared to annuloplasty alone in patients with ischemic MR, though it does not significantly enhance left ventricular reverse remodeling.
May reduce MR recurrence after annuloplasty in ischemic MR; leaves open whether it improves LV remodeling or outcomes.
BACKGROUND AND AIMS: The main pathophysiological factor of chronic ischemic mitral regurgitation (MR) is the outward displacement of the papillary muscles (PMs) leading to leaflet tethering. For this reason, papillary muscle intervention (PMI) in combination with mitral ring annuloplasty (MRA) has recently been introduced into clinical practice to correct this displacement, and to reduce the recurrence of regurgitation. METHODS: A meta-analysis was conducted comparing the outcomes of PMI and MRA performed in combination vs MRA performed alone, in terms of MR recurrence and left ventricular reverse remodeling (LVRR). A meta-regression was carried out to investigate the impact of the type of PMI procedure on the outcomes. RESULTS: = 0.0%; p = .44; Egger's test: intercept 0.35 [-0.78 to 1.51]; p = .42). The group with both PMI and MRA and that with only MRA showed a slightly higher reduction in left ventricular diameters (-5.94%; -8.75% to 3.13%,). However, in both groups, LVRR was <10%. No difference was detected between PM relocation/repositioning and papillary muscle approximation in terms of LVRR (p = .33). CONCLUSIONS: Using PMI and MRA together has a lower MR recurrence than using MRA alone. No significant LVRR was observed between the two groups nor between the PMI techniques employed.
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Micali et al. (2020) conducted a meta-analysis in chronic ischemic mitral regurgitation. Papillary muscle intervention (PMI) and mitral ring annuloplasty (MRA) vs. Mitral ring annuloplasty (MRA) alone was evaluated on Mitral regurgitation recurrence and left ventricular reverse remodeling (LVRR). Papillary muscle intervention combined with mitral ring annuloplasty lowered MR recurrence vs annuloplasty alone, but left ventricular reverse remodeling was <10% in both groups.
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