Long-term effect of papillary muscle approximation combined with ventriculoplasty on left ventricle function in patients with ischemic cardiomyopathy and functional mitral regurgitation☆

Abstract

One of the mechanisms of development of functional mitral regurgitation after myocardial infarction is the increased papillary muscle distance which results due to ventricle remodeling. The aim of this study was to investigate the long-term effect of papillary muscle approximation (PMA) on the cardiac function of patients with ischemic cardiomyopathy and increased papillary muscle distance. Thirty patients (22 males; mean age: 57.0 ± 7.4 years) selected for coronary artery bypass grafting (CABG) underwent ventriculoplasty. Additionally, 50% of the study population also underwent PMA (group 1). All the patients had preoperative grade 3 or 4 mitral regurgitation with an inter-papillary muscle distance > 2.5 cm. In group 1, the papillary muscles were drawn together using an encircling loop. Mitral annuloplasty and the Dor procedure were performed in all the patients. Follow-up time was 41.5 ± 5.8 months and 42.7 ± 3.3 months in groups 1 and 2, respectively (p-value=0.49). The two groups had no significant difference regarding the annulus diameter, ring size, number of grafts, and concavity area. There was one case of in-hospital mortality in each group, and one patient in group 2 had expired by the last follow-up. Postoperative echocardiography revealed significant changes in the concavity area, ejection fraction, and sphericity index in the PMA group by comparison to group 2 (p-value < 0.05). In patients with ischemic mitral regurgitation and increased papillary muscle distance, PMA as an adjunct to CABG results in better left ventricle function and shape, even at long-term follow-up.