Key result
Anterior papillary muscle relocation combined with restrictive mitral annuloplasty preserved diastolic mitral valve opening, whereas posterior relocation severely restricted it compared to annuloplasty alone.
Why the study?
Does papillary muscle relocation in addition to restrictive mitral annuloplasty improve mitral valve configuration and reduce recurrent MR in patients with functional mitral regurgitation?
Observational (n=39)
No
Does papillary muscle relocation in addition to restrictive mitral annuloplasty improve mitral valve configuration and reduce recurrent MR in patients with functional mitral regurgitation?
p-value: p=<0.01
In the surgical treatment of functional mitral regurgitation, adding anterior papillary muscle relocation to restrictive mitral annuloplasty prevents recurrent MR while preserving diastolic mitral valve opening.
May inform relocation site selection to avoid diastolic restriction in functional MR repair; leaves open effects on recurrent MR pending RCTs.
BACKGROUND: After restrictive mitral annuloplasty (RMAP) for functional mitral regurgitation (MR), the MR frequently recurs. Papillary muscle relocation (PMR) should reduce the recurrence rate. We assessed the influence of procedural differences in PMR on the postoperative mitral valve configuration. METHODS: Thirty-nine patients who underwent mitral valve repair for functional MR were enrolled. In limited tethering cases, RMAP alone was performed (RMAP group; n = 23). In severe tethering cases, in addition to RMAP, bilateral papillary muscles were relocated in the direction of the posterior annulus (posterior PMR group; n = 10) or anterior annulus (anterior PMR group; n = 6). We performed pre- and postoperative transthoracic echocardiographic studies, introducing a new index, mitral inflow angle (MIA), to assess the diastolic mitral leaflet excursion. MIA was measured as the angle between the mitral annular plane and the bisector of the anterior and posterior leaflets. RESULTS: Postoperative MR grade was significantly reduced in each group (P < 0.001). Follow-up echocardiography showed recurrent MR in 13% of the patients in RMAP group. In contrast, no recurrent MR was observed in either the anterior PMR or the posterior PMR group. After surgery, MIA was significantly reduced in both the RMAP group (P < 0.01) and the posterior PMR group (P < 0.001), but was preserved in the anterior PMR group (NS). None of the postoperative variables showed any significant difference between the early and late postoperative phases. CONCLUSIONS: In the surgical treatment of functional MR, a PMR procedure in addition to RMAP was effective in reducing systolic MR. However, mitral valve opening assessed by MIA was restricted even after RMAP alone. The restriction was severely augmented after additional posterior PMR, but was attenuated after additional anterior PMR. The papillary muscle should be relocated in the direction of the anterior annulus to preserve the diastolic opening of the mitral valve.
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Watanabe et al. (2014) conducted an observational in Functional mitral regurgitation (n=39). Anterior or posterior papillary muscle relocation (PMR) with restrictive mitral annuloplasty (RMAP) vs. Restrictive mitral annuloplasty (RMAP) alone was evaluated on Postoperative mitral inflow angle (MIA) (p=<0.01). Anterior papillary muscle relocation combined with restrictive mitral annuloplasty preserved diastolic mitral valve opening, whereas posterior relocation severely restricted it compared to annuloplasty alone.
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