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| The Papillary Muscle Sling for Ischemic Mitral Regurgitation | |
U. Hvass, Thomas Joudinaud; heart surgery, bichat hospital, Paris, France
Methods: Since June 2000, thirty-seven patients with ischemic FMR have benefited from a double-level mitral repair associating an intra-ventricular peri-papillary muscle sling completed by a classical intra-atrial mitral annuloplasty ring. (mean age 64 yrs, LVEDD 70±0mm LVESD 55±5,6mm, ejection fraction 15 to 45%, pulmonary hypertension > 60, NYHA III-IV). All patients had both papillary muscles (PM) encircled with a 4mm gore-tex tube, correcting their lateral and downwards displacement. Annuloplasty rings are moderately undersized or normal. Efficiency was evaluated on mitral stability or recurrence rates of FMR, ventricular parameters and functional status. According to the Leyden algorhythm based on pre-operative end diastolic and end systolic left ventricular diameters, only a minority of our patients were expected to experience reverse remodelling. Results: Regurgitation is none to trivial in 33, mild to moderate in four. Follow-up, 3 to 74 months, mean 53±22 months shows stability of all initially successful double level mitral repairs. Ventricular diameters, ejection fraction, volume, and sphericity index significantly improve. Two patients died during follow-up and one was transplanted. Conclusion: Re-approximating the PM has an immediate effect on mitral leaflet mobility by suppressing the tethering due to displacement of the PM. It has an effect in preventing recurrent MR by forbidding further PM displacement. In this cohort of severely disabled patients, reverse remodelling can be expected. Back to 2009 Annual Meeting Back to Program Outline Back to Main Program |
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