Relationship Between Position, Shape, and Deformation of Papillary Muscles and Mitral Regurgitation After Transcatheter Aortic Valve Replacement

Background Moderate/severe mitral regurgitation (MR) can affect the prognosis of patients with transcatheter aortic valve replacement (TAVR). However, few studies have focused on the role played by papillary muscles (PMs). Aims We intend to explore the relationship between PMs and MR outcome after TAVR. Methods This retrospective cohort study included 1159 consecutive patients who underwent TAVR. The 125 patients who had MR ≥ 3+ grade were divided into improved MR (IMR) group and non‐improved (NMR) group according to the grading of MR at 6 months after operation. MSCT was used to analyze the shape and locate the attachment of PMs. The deformation and synchrony of the PMs attachment were analyzed using two‐dimensional speckle tracking. Associations with MR improvement after TAVR were explored. Results A total of 125 patients (IMR 93 and NMR 32; mean age, 72 years ± 8) were included. There was no significant difference in the deformation and synchrony of myocardium at attachment and in the PMs morphology between groups. However, the range of PM attachment was increased in the NMR group compared to the IMR group (1.94 ± 0.91 vs. 1.40 ± 0.65, p = 0.004; 2.16 ± 0.88 vs. 1.80 ± 0.80, p = 0.035). Inferior displacement of PMs (OR: 5.629; 95% CI: 1.421, 22.293; p = 0.014) was found to be an independent predictor of less MR improvement after TAVR. Conclusion The PMs in the NMR group had no significant morphological tendency, but their attachment range was significantly increased and more toward apical. Inferior displacement of PMs was an independent risk factor for unalleviated MR. Trial Registration: ChiCTR 2000033419.