Long-term results of mitral valve repair: posterior papillary muscle repositioning versus chordal shortening

• Published in: European journal of cardio-thoracic surgery Vol. 16; no. 1; pp. 81 - 87
• Main Authors: Dreyfus, Gilles, Al Aylé, Naji, Dubois, Claude, de Lentdecker, Philippe
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Amsterdam Elsevier Science B.V 01.07.1999; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Cardiac Surgical Procedures - methods; Chordae Tendineae - surgery; Chordal shortening; Echocardiography, Doppler; Feasibility Studies; Female; Humans; Male; Medical sciences; Middle Aged; Mitral repair; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - surgery; Papillary Muscles - surgery; Posterior papillary muscle repositioning; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Posterior papillary muscle repositioning; Mitral repair; Chordal shortening; Human; Mitral valve; Prognosis; Cardiac valvular disease; Surgery; Mitral regurgitation; Cardiovascular disease; Long term
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(99)00130-X

Objective: Mitral valve repair is considered as the gold standard to treat mitral regurgitation. However anterior leaflet prolapse in the posterior paramedial and paracommissural area remains a challenging problem. Indeed several elongated chordae may arise from a single posterior papillary muscle head which does not allow safe separate chordal shortening (CS). We therefore suggest use of papillary muscle repositioning in such cases. Methods: In a cohort of 180 mitral valve repair performed between 1989 and May 1998, we have retrospectively studied 100 consecutive patients who underwent anterior leaflet repair in the posterior paramedial and paracommissural area. Group I (n=60) had posterior papillary muscle repositioning (PPMR) and group II (n=40) had CS. There was no statistical difference between the two groups concerning age, functional class and left ventricular function. Etiology was similar in both groups, degenerative process being predominant. At echocardiogram, regurgitation was graded 3.4/4 in both groups. There was no statistical difference concerning preoperative ejection fraction, end systolic and end diastolic left ventricular diameter. Results: There were no in-hospital deaths in group I and two deaths in group II not related to mitral valve repair. Mean follow up is 26.4±24.2 months in group I and 46.1±28.8 months in group II. No patient was lost to follow up. Severe mitral regurgitation was not observed. Mean regurgitation at follow up was 0.8±0.7 in group I and 0.8±0.8 in group II (P=n.s.); there was no statistical difference between the two groups concerning postoperative ejection fraction, end systolic and end diastolic left ventricular diameter. There was no late cardiac death in either group and there were no thromboembolic events. Actuarial survival rate is 100% and 94.4% in group I and 92% and 84.4% in group II at 2 and 6 years, respectively. Conclusion: This experience shows that PPMR provides as good longterm results as CS to repair anterior leaflet prolapse in posterior paramedial and paracommissural area with lesser morbidity and mortality.