ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2022 February;63(1):99-105

DOI: 10.23736/S0021-9509.21.11843-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Left ventricular remodeling after mitral valve repair and papillary muscle approximation

Priscilla WESSLY ¹, Denisse DIAZ ¹, Rafle FERNANDEZ ¹, Mark J. LARRALDE ¹, Sofia A. HORVATH ¹, Steve XYDAS ², Christos G. MIHOS ¹ ✉

¹ Division of Cardiology, Echocardiography Laboratory, Columbia University, Miami Beach, FL, USA; ² Division of Cardiac Surgery, Columbia University, Mount Sinai Heart Institute, Miami Beach, FL, USA

BACKGROUND: Mitral valve repair with papillary muscle approximation (MVr-PMA) for severe secondary mitral regurgitation (MR) decreases MR recurrence compared with MVr alone. This study assessed the effects of MVr-PMA on left ventricular (LV) remodeling and shape, systolic function and strain mechanics.
METHODS: Forty-eight patients who underwent MVr-PMA for severe secondary MR and had follow-up echocardiograms available for review were identified. Student’s t-test, linear regression modeling, and receiver-operating characteristic curves were used in the statistical analyses.
RESULTS: Median follow-up time was 14.9 months. MVr-PMA was associated with significant LV reverse remodeling with a smaller LV end-diastolic diameter, Systolic Sphericity Index, and interpapillary muscle distance at follow-up. Nine patients (18.8%) experienced moderate recurrent MR. When compared to recurrent MR patients at follow-up, those with durable MVr-PMA had a greater LV ejection fraction (32.8 vs. 22.0%, P=0.03), a smaller end-diastolic diameter (59.6 vs. 67.3 mm, P=0.03), Systolic Sphericity Index (0.35 vs. 0.47, P=0.03), and end-systolic interpapillary muscle distance (16.3 vs. 21.1 mm, P=0.03). A durable MVr-PMA also resulted in stable global longitudinal strain when compared with pre-operative values, while the recurrent MR group experienced a further decline (no recurrent MR: -8.4 vs. -7.5%; recurrent MR: -8.2 vs. -5.4%; P<0.05). A pre-operative LV end-diastolic diameter ≥ 64 mm was a discriminative predictor of MR recurrence (sensitivity=100%, specificity=51%, AUC=0.756, P=0.02).
CONCLUSIONS: A durable MVr-PMA confers improved LV geometry and function, and stable LV mechanics. The extent of baseline LV remodeling identifies patients at risk for recurrent MR.

KEY WORDS: Mitral valve insufficiency; Heart failure; Mitral valve annuloplasty