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Papillary muscle intervention vs mitral ring annuloplasty in ischemic mitral regurgitation
Linda R Micali1, Mohammad N Qadrouh1, Orlando Parise1
1Department of Cardiothoracic Surgery, Maastricht University Hospital, Maastricht, The Netherlands.
Background And Aims:
The main pathophysiological factor of chronic ischemic mitral regurgitation (MR) is the outward displacement of the papillary muscles (PMs) leading to leaflet tethering. For this reason, papillary muscle intervention (PMI) in combination with mitral ring annuloplasty (MRA) has recently been introduced into clinical practice to correct this displacement, and to reduce the recurrence of regurgitation.
Methods:
A meta-analysis was conducted comparing the outcomes of PMI and MRA performed in combination vs MRA performed alone, in terms of MR recurrence and left ventricular reverse remodeling (LVRR). A meta-regression was carried out to investigate the impact of the type of PMI procedure on the outcomes.
Results:
MR recurrence in patients undergoing both PMI and MRA was lower than in those who only had MRA (log incidence rate ratio, -0.66; lower-upper limits, -1.13 to 0.20; I2 = 0.0%; p = .44; Egger's test: intercept 0.35 [-0.78 to 1.51]; p = .42). The group with both PMI and MRA and that with only MRA showed a slightly higher reduction in left ventricular diameters (-5.94%; -8.75% to 3.13%,). However, in both groups, LVRR was <10%. No difference was detected between PM relocation/repositioning and papillary muscle approximation in terms of LVRR (p = .33).
Conclusions:
Using PMI and MRA together has a lower MR recurrence than using MRA alone. No significant LVRR was observed between the two groups nor between the PMI techniques employed.
Insights
Combining papillary muscle intervention (PMI) with mitral ring annuloplasty (MRA) reduces mitral regurgitation (MR) recurrence compared to MRA alone. However, both approaches showed limited left ventricular reverse remodeling (LVRR).
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Cardiac Mechanics
Background:
- Chronic ischemic mitral regurgitation (MR) is primarily caused by outward papillary muscle (PM) displacement, leading to leaflet tethering.
- Papillary muscle intervention (PMI) combined with mitral ring annuloplasty (MRA) is a novel approach to address PM displacement and reduce MR recurrence.
Purpose of the Study:
- To compare the efficacy of combined PMI and MRA versus MRA alone in managing chronic ischemic MR.
- To evaluate the impact of different PMI techniques on clinical outcomes.
Main Methods:
- A meta-analysis was performed comparing outcomes of combined PMI and MRA versus MRA alone.
- Key outcomes assessed included MR recurrence and left ventricular reverse remodeling (LVRR).
- Meta-regression was used to analyze the influence of specific PMI procedures.
Main Results:
- Combined PMI and MRA demonstrated a statistically significant reduction in MR recurrence compared to MRA alone.
- Both treatment groups showed a modest reduction in left ventricular diameters, but LVRR was less than 10% in both.
- No significant difference in LVRR was observed between PM relocation/repositioning and papillary muscle approximation techniques.
Conclusions:
- The combination of PMI and MRA is more effective in preventing MR recurrence than MRA alone.
- Significant LVRR was not achieved with either combined therapy or MRA alone.
- The specific type of PMI technique did not influence LVRR outcomes.
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