Please use this identifier to cite or link to this item: doi:10.22028/D291-39810
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Title: Bilateral papillary muscle repositioning: successful repair of functional mitral regurgitation in dilative cardiomyopathy
Author(s): Langer, Frank
Kunihara, Takashi
Miyahara, Shunsuke
Fahrig, Lisa
Blümel, Maria
Klär, Annika
Raddatz, Alexander
Karliova, Irem
Bekhit, Abdelshafi
Schäfers, Hans-Joachim
Language: English
Title: European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
Volume: 57
Issue: 2
Pages: 285–292
Publisher/Platform: Oxford University Press
Year of Publication: 2020
Free key words: Functional mitral regurgitation
Dilative cardiomyopathy
Mitral valve repair
DDC notations: 610 Medicine and health
Publikation type: Journal Article
Abstract: Functional mitral regurgitation (FMR) in patients with non-ischaemic dilative cardiomyopathy (DCM) is associated with heart failure and poor outcome. Aggressively undersized annuloplasty as an annular solution for a ventricular problem ameliorates heart failure but may be associated with recurrent FMR and does not improve survival. We sought to analyse if moderately undersized annuloplasty with repositioning of both papillary muscles can lead to improved valve stability and outcome in patients with DCM and FMR. In 66 patients with DCM-associated FMR (age 66 ± 12 years, ejection fraction 29 ± 6% and mean pulmonary artery pressure 35 ± 11 mmHg) and severe leaflet tethering (tenting height ≥10 mm) bilateral papillary muscle repositioning was added to moderately undersized ring annuloplasty (median size 30 mm). Concomitant surgery included tricuspid valve repair in 86% of patients and atrial ablation in 44%. RESULTS The early mortality rate was 9%. Overall 5-year freedom from all-cause death, left ventricular assist device implantation or heart transplant was 58% (95% confidence interval 45–71%). Six patients underwent reoperation (redo repair n = 4). Reverse remodelling was observed during follow-up in 66% of patients with decreasing left ventricular end-diastolic diameters (66 ± 5 to 61 ± 12 mm; P < 0.001) and left ventricular end-systolic diameters (56 ± 9 to 51 ± 14 mm; P = 0.001). Subgroup analyses (partial versus complete ring, preoperative left ventricular end-diastolic diameters <65 mm vs left ventricular end-diastolic diameter ≥65 mm) documented similar survival rates. A competing risks regression analysis identified cerebral vascular disease (P = 0.01), use of a partial ring (P = 0.03) and absence of tricuspid valve repair (P = 0.03) as independent predictors of death. CONCLUSIONS The combination of bilateral papillary muscle repositioning and moderately undersized ring annuloplasty leads to stable mid-term repair results and reverse remodelling in patients with DCM and FMR and severe leaflet tethering.
DOI of the first publication: 10.1093/ejcts/ezz204
URL of the first publication:
Link to this record: urn:nbn:de:bsz:291--ds-398107
ISSN: 1010-7940
Date of registration: 22-May-2023
Faculty: M - Medizinische Fakultät
Department: M - Chirurgie
Professorship: M - Prof. Dr. Hans Joachim Schäfers
Collections:SciDok - Der Wissenschaftsserver der Universität des Saarlandes

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