Papillary muscle relocation and mitral annuloplasty in ischemic mitral valve regurgitation: Midterm results

Objectives: The surgical approach for ischemic mitral regurgitation remains unclear. Many studies are in favor of adding the subvalvular procedure to mitral annuloplasty to reduce recurrent mitral regurgitation. This study reports the clinical and echocardiographic outcomes of papillary muscle relocation combined with mitral annuloplasty. Methods: From 2003, 115 patients with severe ischemic mitral regurgitation who underwent papillary muscle relocation plus nonrestrictive mitral annuloplasty and coronary artery bypass grafting were retrospective analyzed. Patients' mean age was 52 +/- 12.8 years, New York Heart Association class III or IV was 71%, and preoperative left ventricular ejection fraction was 43% +/- 6%. The study end points were New York Heart Association functional class, reversal in left ventricle remodeling, reduction of mean tenting area and mean coaptation depth, freedom from cardiac-related deaths and events, and freedom from recurrent mitral regurgitation. Follow-up data were obtained in all patients and were 100% complete. Mean follow-up was 45 +/- 6 months. Results: Five-year freedom from cardiac-related death and events was 91.3% +/- 1.6% and 84% +/- 2.2%, respectively. Recurrent mitral regurgitation more than moderate occurred in 3 patients (2.7%). Reversal in left ventricular remodeling, measured by a change in the end-diastolic and systolic diameter, was observed in our patients (P < .05). The postoperative mean tenting area and mean coaptation depth were 1.1 +/- 0.2 cm(2) and 0.5 +/- 0.2 cm, respectively; 95% of the patients were in New York Heart Association functional class I and II. Conclusions: In patients with ischemic mitral regurgitation, papillary muscle relocation plus nonrestrictive mitral annuloplasty promotes a significant reversal in left ventricular remodeling, with a considerable decrease in tenting area and coaptation depth. Our approach is a durable method to reduce the recurrence of mitral insufficiency.