Boston - American Association for Thoracic Surgery

AMERICAN ASSOCIATION FOR THORACIC SURGERYTUESDAY AFTERNOONMAY 12, 20092:00 p.m. SIMULTANEOUS SCIENTIFIC SESSION –ADULT CARDIAC SURGERYBallroom A–C, Hynes Convention Center(8 minutes presentation, 12 minutes discussion)Moderators: Joseph F. SabikDavid H. Adams35. The Papillary Muscle Sling for Ischemic Mitral RegurgitationU. Hvass, Thomas JoudinaudHeart Surgery, Bichat Hospital, Paris, FranceInvited Discussant: Robert A. DionOBJECTIVE: Evaluate long-term stability of mitral repair and reverse remodellingin patients with severe ischemic left ventricular dysfunction (LVD) and functionalmitral regurgitation (FMR).TUESDAYAfternoonMETHODS: Since June 2000, thirty-seven patients with ischemic FMR havebenefited from a double-level mitral repair associating an intra-ventricular peripapillarymuscle sling completed by a classical intra-atrial mitral annuloplastyring. (mean age 64 yrs, LVEDD 70 ± 0 mm LVESD 55 ± 5,6 mm, ejection fraction15 to 45%, pulmonary hypertension >60, NYHA III-IV). All patients had bothpapillary muscles (PM) encircled with a 4 mm gore-tex tube, correcting their lateraland downwards displacement. Annuloplasty rings are moderately undersized ornormal. Efficiency was evaluated on mitral stability or recurrence rates of FMR,ventricular parameters and functional status. According to the Leyden algorhythmbased on pre-operative end diastolic and end systolic left ventricular diameters,only a minority of our patients were expected to experience reverse remodelling.RESULTS: Regurgitation is none to trivial in 33, mild to moderate in four. Follow-up,3 to 74 months, mean 53 ± 22 months shows stability of all initially successful doublelevel mitral repairs. Ventricular diameters, ejection fraction, volume, and sphericityindex significantly improve. Two patients died during follow-up and one wastransplanted.CONCLUSION: Re-approximating the PM has an immediate effect on mitralleaflet mobility by suppressing the tethering due to displacement of the PM. It hasan effect in preventing recurrent MR by forbidding further PM displacement. Inthis cohort of severely disabled patients, reverse remodelling can be expected.163