Key result
Subannular papillary muscle repositioning significantly reduced the papillary muscle to mitral annulus distance from a preoperative median of 30 mm to 25 mm postoperatively (P=0.001).
Why the study?
The study aimed to quantify the effect of papillary muscle repositioning on papillary muscle geometry and evaluate whether improved geometry translates into global LV reverse remodelling in severe FMR type IIIb.
Does mitral valve repair with subannular papillary muscle repositioning improve left ventricular geometry in patients with severe functional mitral regurgitation type IIIb?
Cohort (n=63)
Does mitral valve repair with subannular papillary muscle repositioning improve left ventricular geometry in patients with severe functional mitral regurgitation type IIIb?
Mitral valve repair with papillary muscle repositioning significantly reduces papillary muscle to mitral annulus distance and promotes left ventricular reverse remodeling in severe FMR type IIIb.
Supports technical feasibility of subannular repositioning; hypothesis-generating for mitral repair durability and outcomes.
OBJECTIVES: Papillary muscle repositioning in functional mitral regurgitation (FMR) alleviates mitral valve (MV) tenting by reducing the distance between papillary muscle tips and MV annular plane, i.e. apical left ventricular (LV) displacement. We aimed to quantify the effect of papillary muscle repositioning on papillary muscle geometry and to evaluate whether improved papillary muscle geometry after papillary muscle repositioning translates into the global LV reverse remodelling in FMR type IIIb. METHODS: Patients with severe FMR type IIIb were prospectively enrolled and underwent pre- and postoperative 1.5-T cardiac magnetic resonance imaging. A new variable was defined, the papillary muscle to mitral annulus distance, which quantifies the distance between papillary muscle tips and MV annular plane. All parameters were measured by 2 independent investigators. RESULTS: A total of 63 patients were enrolled. In all patients, papillary muscle to mitral annulus distance correlated significantly with established markers of LV remodelling and MV tenting severity. In patients who underwent subannular papillary muscle repositioning procedure (surgical cohort, n = 23), preoperative median papillary muscle to mitral annulus distance was 30 mm [interquartile range (IQR): 27-34 mm] and was significantly reduced postoperatively to 25 mm (IQR: 21-27 mm) (P = 0.001). LV end-diastolic diameter was reduced from 66 mm (IQR: 60-71) preoperatively to 58 mm (IQR: 53-67) after the surgery (P = 0.001). CONCLUSIONS: MV repair with papillary muscle repositioning results in a papillary muscle to mitral annulus distance reduction and significantly improved MV tenting parameters. Improved papillary muscle geometry after papillary muscle repositioning is associated with a global LV reverse remodelling and may, thereby, improve the prognosis of FMR patients.
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Sinn et al. (2022) conducted a cohort in Severe functional mitral regurgitation (FMR) type IIIb (n=63). Subannular papillary muscle repositioning vs. Preoperative state was evaluated on Papillary muscle to mitral annulus distance (p=0.001). Subannular papillary muscle repositioning significantly reduced the papillary muscle to mitral annulus distance from a preoperative median of 30 mm to 25 mm postoperatively (P=0.001).
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