[Dual Repair for Ischemic/Functional Mitral Regurgitation]

In the era of M-clip, surgery for ischemic/functional mitral regurgitation( FMR) which is a ventricular disease remains a challenge. We try to do ventricular treatment as much as possible. We reviewed 11 patients( 9 males, 63±12 years old) who had "dual repair" surgery which consists of anterior relocation of both papillary heads/muscles and simplified ventricular restoration (frozen-apex restoration). There was 1 hospital death of mesenteric ischemia in a 80 years old patient with sarcoidosis and chronic kidney disease(CKD). FMR changed from 2.7±0.9 preoperatively to 0.9±0.5( p<0.001) postoperatively. Similarly, New York Heart Association (NYHA) class from 3.7±0.8 to 1.8±0.6 (p<0.001), left ventricular end-diastolic dimension (LVDd) from 72±12 to 67±12 mm (p<0.01), end-systolic dimension (Ds) from 65±12 to 59±14 mm (p<0.01), ejection fraction (EF) from 23±8 to 28±10 (p=0.04), and right ventricular pressure( RVP) from 38±13 to 31±8 mmHg. There was no late death with the follow-up of 20±15 months (range 2∼42 months). In conclusion, ventricular treatment by "dual repair" surgery helps patients with FMR. Surgery may be a good compensatory treatment for catheter intervention.