Impact of Papillary Muscle Relocation in the Surgical Repair for Functional Mitral Regurgitation

Abstract

Background: Although adaptive servo-ventilation (ASV) has a beneficial impact on patients with chronic heart failure (CHF), little is known about its effects on the functional mitral regurgitation (FMR) of CHF patients. The aim of our present study was to test the hypothesis that ASV would improve the severity of FMR. Methods: Echocardiographic parameters were measured in 30 CHF patients with FMR who initiated ASV therapy and underwent follow-up echocardiography after six months of ASV. Patients were divided into two groups; an ASV group (n520) and a withdrawal group (n510). Results: In the follow-up study, a significant reduction of the left ventricular (LV) and left atrial (LA) volumes, and improved systolic (LV ejection fraction) and diastolic function (E/e’) parameters were observed in the ASV group. The severity of FMR (vena contracta width), tenting area and mitral annular area were also improved. These beneficial effects were not observed in the withdrawal group. There were significant correlations between the changes in the severity of FMR and the LV end-diastolic volume, end-systolic volume and LA volume. Conclusion: We have found a significant reduction in the severity of FMR in CHF patients treated with ASV therapy. Our data suggest that chronic ASV therapy produces LV and LA reverse remodeling, resulting in an improvement in LV function and the severity of FMR in patients with CHF.