Papillary muscle repair surgery in ischemic mitral valve patients

Background. Ischemic mitral regurgitation (MR), when ischemia/infarction ha s resulted in fibrotic degeneration and elongation of papillary muscles, ca rries a high risk for the patient and a technical challenge for the surgeon . We have developed a papillary-shortening plasty for this specific patholo gy. Methods. Papillary muscle repair was performed in 88 patients (7.2%) where degenerated and fibrotic elongated papillary muscles were found, which resu lted in a prolapse of one or more parts of the mitral valve leaflets (MR II I-IV). All patients had a papillary muscle-shortening plasty using a perica rdium pledged-reinforced polytetrafluoroethylene suture and a ring annulopl asty. Because the cause of regurgitation in this specific group of patients was ischemic, concomitant coronary bypass grafting was required in all pat ients, with 2.2 grafts/patient. Results. There were Eve hospital deaths (5.70ib). Postoperative mitral valv e function was satisfactory in all patients: no residual mitral regurgitati on (MR 0) was found in 80 patients (90.9%), mild regurgitation (MR I) in 5 patients (5.7%), and moderate regurgitation (MR I-II) was observed in 3 pat ients (3.4%). Within a short mean follow-up period of 18.6 months (3 to 40 months), there was one late death (1.2%). The actuarial freedom from reoper ation and thromboembolic complications was 100%, but there were two anticoa gulation-induced gastric bleeding complications (2.3%). All patients were i n New York Heart Association functional class I or II at the time of follow -up. Conclusions. Our data show that careful assessment of papillary muscle path ology is mandatory, and that a papillary muscle-shortening plasty is a simp le but valuable surgical tool to repair the mitral valve in this specific g roup of high-risk patients with ischemic mitral regurgitation. (Ann Thorac Surg 2000;70:771-7) (C) 2000 by The Society of Thoracic Surgeons.