What does this research mean for the field?

In patients with rheumatic mitral stenosis and preserved left ventricular systolic function, adding papillary muscle repositioning to mechanical mitral valve replacement improves left ventricular dimensions, ejection fraction, and sphericity index at 18 months without increasing surgical risks. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 1, 2014Texas Heart Institute JournalOpen Access

Papillary Muscle Repositioning as a Subvalvular Apparatus Preservation Technique in Mitral Stenosis Patients with Normal Left Ventricular Systolic Function

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Why the study?

Does papillary muscle repositioning added to mitral valve replacement improve echocardiographic left ventricular function in patients with rheumatic mitral stenosis and normal left ventricular systolic function?

Population

115 patients with rheumatic mitral stenosis and normal left ventricular systolic function scheduled for…

Comparison

Papillary muscle repositioning added to mitral… vs Mitral valve replacement only with a mechanical…

Design

Cohort

Follow-up

18 months

Authors

GLGökhan LafçıSamsun University KÇKerim ÇağlıTürkiye Yüksek İhtisas Hastanesi ÖÇÖmer Faruk ÇiçekSelçuk University

Discussion

Member takes

Implication

May support PMR addition to MVR for LV remodeling in rheumatic MS; leaves open randomized confirmation.

Key Points

To determine the effects of papillary muscle repositioning on clinical outcomes and echocardiographic left ventricular function in patients with rheumatic mitral stenosis undergoing mechanical valve replacement.
Prospective study of 115 patients with rheumatic mitral stenosis and preserved left ventricular systolic function scheduled for mechanical mitral valve replacement.
Assigned patients to either papillary muscle repositioning (PMR, n=48) or standard valve replacement (MVR-only, n=67).
Evaluated functional class, perioperative complications, and echocardiographic variables at baseline and over an 18-month follow-up.
Mean left ventricular ejection fraction significantly deteriorated in the MVR-only group over 18 months, whereas it consistently improved in the PMR group.
Reductions in left ventricular end-diastolic diameter, end-systolic diameter, and sphericity index were significantly greater in the PMR group compared to the MVR-only group.
Baseline patient characteristics, operative variables, and perioperative mortality were similar between both treatment cohorts.

Structured PICO

Population

115 patients with rheumatic mitral stenosis and normal left ventricular systolic function scheduled for mitral valve replacement (MVR) surgery with a mechanical prosthesis.

Intervention

Papillary muscle repositioning (PMR) added to mitral valve replacement (MVR) with a mechanical prosthesis

Comparator

Mitral valve replacement (MVR) only with a mechanical prosthesis

Outcome

Clinical outcomes (functional class) and echocardiographic left ventricular function (LVEF, LV dimensions, sphericity index) at 18-month follow-upsurrogate

In patients with rheumatic mitral stenosis and preserved LV systolic function, adding papillary muscle repositioning to mechanical MVR improves LV dimensions and ejection fraction at 18 months without increasing perioperative mortality.

Cite This Study

Lafçı et al. (2014) studied this question.

synapsesocial.com/papers/6a1d2721748c408e6fd3151d https://doi.org/10.14503/thij-13-3241

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Papillary Muscle Repositioning as a Subvalvular Apparatus Preservation Technique in Mitral Stenosis Patients with Normal Left Ventricular Systolic Function

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Papillary Muscle Repositioning as a Subvalvular Apparatus Preservation Technique in Mitral Stenosis Patients with Normal Left Ventricular Systolic Function

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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