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

DOI: 10.23736/S0021-9509.21.11843-9


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

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