Papillary muscle intervention vs mitral ring annuloplasty in ischemic mitral regurgitation

L.R. Micali, M.N. Qadrouh, O. Parise, G. Parise, F. Matteucci, M. de Jong, C. Tetta, A.I. Moula, D.M. Johnson, S. Gelsomino*

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

2 Citations (Web of Science)

Abstract

Background and Aims The main pathophysiological factor of chronic ischemic mitral regurgitation (MR) is the outward displacement of the papillary muscles (PMs) leading to leaflet tethering. For this reason, papillary muscle intervention (PMI) in combination with mitral ring annuloplasty (MRA) has recently been introduced into clinical practice to correct this displacement, and to reduce the recurrence of regurgitation.Methods A meta-analysis was conducted comparing the outcomes of PMI and MRA performed in combination vs MRA performed alone, in terms of MR recurrence and left ventricular reverse remodeling (LVRR). A meta-regression was carried out to investigate the impact of the type of PMI procedure on the outcomes.Results MR recurrence in patients undergoing both PMI and MRA was lower than in those who only had MRA (log incidence rate ratio, -0.66; lower-upper limits, -1.13 to 0.20; I-2 = 0.0%; p = .44; Egger's test: intercept 0.35 [-0.78 to 1.51]; p = .42).The group with both PMI and MRA and that with only MRA showed a slightly higher reduction in left ventricular diameters (-5.94%; -8.75% to 3.13%,). However, in both groups, LVRR was <10%. No difference was detected between PM relocation/repositioning and papillary muscle approximation in terms of LVRR (p = .33).Conclusions Using PMI and MRA together has a lower MR recurrence than using MRA alone. No significant LVRR was observed between the two groups nor between the PMI techniques employed.
Original languageEnglish
Pages (from-to)645-653
Number of pages9
JournalJournal of Cardiac Surgery
Volume35
Issue number3
DOIs
Publication statusPublished - 1 Mar 2020

Keywords

  • approximation
  • configuration
  • impact
  • inferior myocardial-infarction
  • insights
  • ischemic mitral regurgitation
  • left ventricular remodeling
  • mechanism
  • mitral annuloplasty
  • mitral regurgitation recurrence
  • papillary muscle intervention
  • relocation
  • repair
  • restrictive annuloplasty
  • valve surgery
  • APPROXIMATION
  • RELOCATION
  • REPAIR
  • RESTRICTIVE ANNULOPLASTY
  • MECHANISM
  • CONFIGURATION
  • INFERIOR MYOCARDIAL-INFARCTION
  • IMPACT
  • VALVE SURGERY
  • INSIGHTS

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