Key result
Annuloplasty with additional papillary muscle relocation reduced the 2-year composite of death or recurrent mitral regurgitation ≥2 compared to isolated annuloplasty (19.6% vs 44.4%; P=0.009).
Why the study?
The major drawback of isolated annuloplasty for type IIIb secondary mitral regurgitation is recurrence, prompting evaluation of additional papillary muscle relocation to address leaflet tethering.
Does annuloplasty with additional papillary muscle relocation reduce death or recurrence of mitral regurgitation in patients with type IIIb secondary mitral regurgitation compared to isolated annuloplasty?
Cohort (n=105)
Does annuloplasty with additional papillary muscle relocation reduce death or recurrence of mitral regurgitation in patients with type IIIb secondary mitral regurgitation compared to isolated annuloplasty?
Absolute Event Rate: 19.6% vs 44.4%
p-value: p=0.009
Adding papillary muscle relocation to annuloplasty significantly improves 2-year outcomes by reducing death or recurrent mitral regurgitation in patients with type IIIb secondary mitral regurgitation.
May support adjunctive papillary muscle relocation during annuloplasty; leaves open need for randomized confirmation.
OBJECTIVES: The major drawback of isolated annuloplasty for treatment of secondary mitral regurgitation (SMR) with restricted leaflet motion during systole (type IIIb) is the recurrence of SMR, leading to adverse clinical outcome. Additional papillary muscle relocation (PMR) specifically addresses leaflet tethering to restore mitral valve geometry. We aimed to compare the 2-year outcome of annuloplasty with additional PMR vs isolated annuloplasty. METHODS: A total of 105 consecutive type IIIb SMR patients with preoperative left ventricular (LV) ejection faction <45%, left ventricular end-diastolic diameter >55 mm and a tenting height >10 mm reached 2-year postoperative follow-up after mitral valve repair and were included in the current analysis. A total of 51 patients underwent annuloplasty and additional PMR (study group). A total of 54 patients underwent isolated annuloplasty (control group). Primary composite study end point comprised death or recurrence of mitral regurgitation ≥2 at 2 years postoperatively. RESULTS: Echocardiographic baseline variables indicating the severity of LV dysfunction and mitral leaflet tethering were similar. Procedural and periprocedural outcome was comparable in both groups. The primary composite end point was significantly improved in the study group (19.6% [10/51]) in comparison to the control group (44.4% [24/54]; P = 0.009). Two-year all-cause mortality was 7.8% [4/51] in the study group vs 18.5% [10/54] in the control group (P = 0.098). After 2 years, a significant improvement in New York Heart Association functional class as compared to the baseline values was observed in the study group. CONCLUSIONS: Additional PMR to treat SMR type IIIb resulted in an improved 2-year outcome in comparison to isolated annuloplasty. PMR specifically addressing mitral leaflet tethering represents a valid therapeutic option for heart failure patients with SMR type IIIb.
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Pausch et al. (2022) conducted a cohort in type IIIb secondary mitral regurgitation (n=105). Annuloplasty with additional papillary muscle relocation vs. Isolated annuloplasty was evaluated on death or recurrence of mitral regurgitation ≥2 at 2 years postoperatively (p=0.009). Annuloplasty with additional papillary muscle relocation reduced the 2-year composite of death or recurrent mitral regurgitation ≥2 compared to isolated annuloplasty (19.6% vs 44.4%; P=0.009).
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