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Review
. 2020 Mar;35(3):645-653.
doi: 10.1111/jocs.14407. Epub 2020 Jan 17.

Papillary muscle intervention vs mitral ring annuloplasty in ischemic mitral regurgitation

Linda R Micali  1 , Mohammad N Qadrouh  1 , Orlando Parise  1 , Gianmarco Parise  1 , Francesco Matteucci  1 , Monique de Jong  1 , Cecilia Tetta  1 , Amalia I Moula  1 , Daniel M Johnson  1 , Sandro Gelsomino  1
Affiliations
Review

Papillary muscle intervention vs mitral ring annuloplasty in ischemic mitral regurgitation

Linda R Micali et al. J Card Surg. 2020 Mar.

Abstract

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.

Keywords: ischemic mitral regurgitation; left ventricular remodeling; mitral annuloplasty; mitral regurgitation recurrence; papillary muscle intervention.

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Conflict of interest statement

The authors declare that there are no conflict of interests.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Review and Meta‐Analyses flow diagram of the selection process
Figure 2
Figure 2
Forest plot of MR recurrence in the PMI + MRA group and isolated MRA group. MR, mitral regurgitation; MRA, mitral ring annuloplasty; PMI, papillary muscle intervention
Figure 3
Figure 3
Bubble plot of the meta‐regression analysis of MR recurrence rate in PMA and PMRel/PMRep. MR, mitral regurgitation; PMA, papillary muscle approximation; PMRel, papillary muscle relocation; PMRep, papillary muscle repositioning
Figure 4
Figure 4
Forest plot of reduction in end‐systolic diameter in the PMI + MRA group and isolated MRA group. MRA, mitral ring annuloplasty; PMI, papillary muscle intervention
Figure 5
Figure 5
Bubble plot of the meta‐regression analysis of left ventricular reverse remodeling (LVRR) in PMA and PMRel/PMRep. MRA, mitral ring annuloplasty; PMA, papillary muscle approximation; PMI, papillary muscle intervention; PMRel, papillary muscle relocation; PMRep, papillary muscle repositioning
See this image and copyright information in PMC

Comment in

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