Key result
Adding papillary muscle approximation and suspension to CABG and mitral annuloplasty significantly reduced anterior and posterior mitral leaflet tethering angles at 1 year compared to annuloplasty alone.
Why the study?
Does the addition of procedures targeting the subvalvular apparatus (SVR, PMA, PMS) to CABG and MAP reduce mitral valve leaflet tethering in patients with ischemic cardiomyopathy and ischemic mitral regurgitation?
Cohort (n=22)
No
Does the addition of procedures targeting the subvalvular apparatus (SVR, PMA, PMS) to CABG and MAP reduce mitral valve leaflet tethering in patients with ischemic cardiomyopathy and ischemic mitral regurgitation?
Absolute Event Rate: 32.5% vs 48.6%
p-value: p=<0.05
Adding subvalvular apparatus targeting procedures (PMA and PMS) to mitral annuloplasty provides persistent reduction of mitral valve leaflet tethering at 1 year in patients with ischemic cardiomyopathy.
Should not yet change surgical practice in ischemic MR; leaves open whether subvalvular procedures improve clinical outcomes.
BACKGROUND: Ischemic mitral regurgitation (IMR) with ischemic cardiomyopathy (ICM) was treated with surgical procedures, and mitral leaflet tethering was assessed. Twenty-two patients with both ICM (left ventricular ejection fraction <0.35) and IMR (>2) underwent coronary artery bypass grafting (CABG), mitral annuloplasty (MAP) with or without surgical ventricular restoration (SVR) and procedures targeting the subvalvular apparatus. METHODS AND RESULTS: Fourteen patients (group 1) underwent CABG and MAP, and the remaining 8 (group 2) underwent CABG, MAP, SVR, papillary muscle approximation (PMA), and papillary muscle suspension (PMS). PMA joined the entire papillary muscles with 3 mattress sutures. For PMS, 2 ePTFE sutures were placed between papillary muscle tips and fibrous annuli. Anterior and posterior mitral leaflet tethering angles (ALA and PLA) relative to the line connecting annuli, posterior and apical displacement of coaptation, and IMR grade were measured on echocardiography. Although preoperative ALA and PLA in group 2 were significantly larger than in group 1, there was no significant difference between groups at 1 month after surgery. At 1 year after surgery, however, the situation reversed: ALA and PLA in group 1 were significantly larger than in group 2. CONCLUSIONS: In addition to MAP, procedures targeting the subvalvular apparatus including PMA and PMS achieved persistent reduction of mitral valve leaflet tethering, which might lead to the improvement of long-term outcome.
No takes yet. Share an insight, caveat, or question.
Yamaguchi et al. (2013) conducted a cohort in Ischemic cardiomyopathy with ischemic mitral regurgitation (n=22). CABG, mitral annuloplasty, surgical ventricular restoration, papillary muscle approximation, and papillary muscle suspension vs. CABG and mitral annuloplasty alone was evaluated on Anterior leaflet angle (ALA) at 1 year after surgery (p=<0.05). Adding papillary muscle approximation and suspension to CABG and mitral annuloplasty significantly reduced anterior and posterior mitral leaflet tethering angles at 1 year compared to annuloplasty alone.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: