Formula-Based Relocation of the Papillary Muscle in Patients With Ischemic Mitral Regurgitation

Abstract

Background

We developed a formula to estimate the optimal distance between the posterior papillary muscle (PPM) and the midseptal fibrous annulus (D_P-A) to facilitate PPM relocation in patients with ischemic mitral regurgitation (IMR) undergoing mitral valve repair.

Methods

D_P-A was measured in 109 patients without valvular disease undergoing electrocardiogram-gated 3-dimensional computed tomography, and a predictive formula that best approximated this value was developed. This formula was evaluated in 10 patients (59.2 [SD, 10.7] years, 7 men) with moderate-severe IMR undergoing mitral valve repair using PPM relocation by 3 surgeons in 6 institutions from 2014 to 2023. Two arms of CV-3 suture fixed at the PPM were passed through the midseptal fibrous annulus to the annuloplasty ring and tied at the length estimated using the formula (35 [SD, 4] mm).

Results

Postoperative echocardiography demonstrated neither residual regurgitation nor leaflet tenting. Three patients died and 1 underwent mitral valve replacement during follow-up (71 [SD, 35] months), but IMR was well controlled, and left ventricular reverse remodeling and improved left ventricular function was observed in the other 6.

Conclusions

This formula facilitates mitral valve repair using PPM relocation in patients with IMR.