A New Surgical Option for Functional Mitral Valve Regurgitation

Objectives: Mitral valve (MV) repair for a functional MV regurgitation (FMR) is still challenging. Annuloplasty has been a widely favored technique for FMR with severe tethering. However, residual and recurrent mitral regurgitation (MR) remains quite common. Mitral annuloplasty can cause augmented posterior leaflet tethering resulting in discordance at the level of the anterior and posterior leaflet tips, and hence a lack of adequate leaflet coaptation. We hypothesize, that this discordance at the level of the leaflet tip is the major cause of residual and recurrent regurgitation after the repair procedures of FMR. Recently, we have developed the “Papillary muscle heads focalization technique” to adjust the levels of leaflet tips in each segment for FMR.

Methods: In this technique, all the separated papillary muscle heads are sutured together, and both the anterolateral and posteromedial papillary muscles are reconstructed to form a single headed papillary muscle. The stitches were positioned equidistant from the top of leaflets for each segment to accurately adjust the level of the MV leaflet tips. An annuloplasty is performed concomitantly.

Result: Since 2016 we have performed the papillary muscle heads focalization method for 29 patients with severe FMR. The age at the time of surgery was 68.8 ± 7.8 years. The causes of MR were ischemic (n = 11) and nonischemic (n = 18). Left ventricular ejection fraction was 45.0 ± 9.7%, left ventricular diastolic dimension was 56.0 ± 7.8 mm, left ventricular systolic dimension was 45.0 ± 9.3 mm, mitral valve tenting height was 6.6 ± 0.5 mm, and posterior mitral leaflet angle was 29.5 ± 17.4 degree in the preoperative echocardiography. One was converted to a MV replacement, due of leaflet calcification. Of the 28 patients who underwent MV repair with the papillary muscle heads focalization method, 17 had demonstrated no MR. 10 showed trivial MR, and 1 showed moderate MR in the postoperative echocardiography at discharge. One showed severe MR one month after surgery because of a tear of the annuloplasty ring and undergone reoperation. In-hospital death was one attributed to pneumonia. The 2-year survival rate was 92.4%. Median follow up time was ~12 months (95% CI: 9.2–20.3 months).

Conclusion: The papillary muscle heads focalization technique is simple but effective and reproducible. This new technique is proposed to be one of an effective surgical option for FMR.

Publication History

Article published online:
19 February 2021