Thorac Cardiovasc Surg 2018; 66(S 01): S1-S110
DOI: 10.1055/s-0038-1627970
Oral Presentations
Monday, February 19, 2018
DGTHG: Valvular Heart Disease: AV-Valves II
Georg Thieme Verlag KG Stuttgart · New York

Subannular Repair in Mitral Valve Surgery for Type IIIb Functional Mitral Regurgitation

E. Harmel
1   Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
J. Pausch
1   Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
B. Kloth
1   Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
C. Sinning
1   Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
J. Kubitz
1   Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
H. Reichenspurner
1   Universitäres Herzzentrum Hamburg, Hamburg, Germany
,
E. Girdauskas
1   Universitäres Herzzentrum Hamburg, Hamburg, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2018 (online)

Objectives: The optimal surgical treatment of functional mitral regurgitation (FMR) with restricted leaflet motion during systole (Type IIIb) is still controversial. The major drawback of isolated undersized mitral annuloplasty in type IIIB MR is the re-occurrence of FMR due to ongoing ventricular remodeling with progressive papillary muscle displacement. Subannular repair techniques have been developed to address this drawback. We aimed to prospectively compare the results of isolated annuloplasty versus annuloplasty with simultaneous standardized subannular repair.

Methods: A consecutive series of 63 type IIIb FMR patients which met the inclusion criteria of (1) left ventricular ejection fraction < 40%, (2) LVEDD > 60mm, (3) tenting height > 10mm, and (4) bileaflet tethering underwent an isolated annuloplasty (n = 37) versus annuloplasty + subannular repair (repositioning of both papillary muscles) (n = 26). Primary study endpoint was the re-occurrence of MR and echocardiographic parameters of residual leaflet tethering after the surgery.

Results: Baseline variables indicating the severity of left ventricular disease (i.e., LV-EF, LVEDD) and mitral valve tethering parameters (i.e., tenting height, tenting area, PML and AML angle) were comparable between the two groups (i.e., study group (annuloplasty + versus control group). Isolated mitral valve repair was performed using a minimally invasive right mini-thoracotomy approach in 50.0% study group versus 33.3% control group respectively. There was no significant difference in in-hospital mortality between the two groups. Post-repair echocardiographic results were compared between both groups early after the surgery and during short-term follow-up. Although there was no significant difference in the residual post-repair MR between study subgroups, residual leaflet tethering parameters (i.e., tenting area (121.5 ± 44.1 (study) versus 177.9 ± 54.4 (control)), PML angle (23.7 ± 6.7 (study) versus 28.8 ± 5.4 (control)), AML angle (23.5 ± 6.2 (study) versus 33.4 ± 5.0 (control)), were significantly increased in the control group (p < 0.001).

Discussion: In this preliminary analysis, combination of annuloplasty with simultaneous standardized subannular repair results in significantly decreased residual leaflet tethering after mitral valve repair for type IIIb FMR as compared with annuloplasty alone. Long-term benefit of subannular repair in terms of improved durability of MV competence and better clinical outcome has to be demonstrated.