Interpapillary Muscle Distance Predicts Recurrent Mitral Regurgitation Independently from End-Diastolic Left Ventricle Diameter. 5-Years Echocardiographic Results from the PMA Trial
Presented During:
Friday, May 5, 2023: 7:25AM - 7:30AM
New York Hilton Midtown
Posted Room Name:
Petit Trianon
Abstract No:
MO061
Submission Type:
Abstract Submission
Authors:
Francesco Nappi (1), Ivancarmine Gambardella (2), Arnaldo Dimagli (3), Cristiano Spadaccio (4), Sanjeet Singh Avtaar Singh (5), Umberto Benedetto (6)
Institutions:
(1) Centre Cardiologique du Nord, France, (2) Weill Cornell Medical Center, New York, NY, (3) Weill Cornell Medical Cente, New York, NY, (4) Mayo Clinic, Department of CV Surgery, Rochester, MN, (5) Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh, Edinburgh, NA, (6) Bristol Heart Institute, Bristol, N/A
Submitting Author:
Francesco Nappi
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Centre Cardiologique du Nord
Centre Cardiologique du Nord
Co-Author(s):
Ivancarmine Gambardella
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Weill Cornell Medical Center
Weill Cornell Medical Center
Arnaldo Dimagli
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Weill Cornell Medical Cente
Weill Cornell Medical Cente
Cristiano Spadaccio
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Mayo Clinic, Department of CV Surgery
Mayo Clinic, Department of CV Surgery
Sanjeet Singh Avtaar Singh
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Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh
Department of Cardiothoracic Surgery, Royal Infirmary of Edinburgh
Umberto Benedetto
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Bristol Heart Institute
Bristol Heart Institute
Presenting Author:
Ivancarmine Gambardella
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Weill Cornell Medical Center
Weill Cornell Medical Center
Abstract:
Objective: Recurrent ischemic mitral regurgitation (IMR) is caused by displacement of papillary muscles due to progressive increase of the left ventricle end-diastolic diameter (LVEDD). We aimed at demonstrate that, if interpapillary muscle distance (IPD) is surgically stabilized, the increase of LVEDD is not associated to recurrent IMR.
Methods: Ninety-six patient with severe IMR were randomized 1:1 for reduction annuloplasty (RA) vs RA + papillary muscle approximation (PMA). At 5 years follow-up, we evaluated: [1] the association of echocardiographic predictors to recurrent IMR (i.e., moderate-severe MR ± reoperation); [2] the correlation of PMA with an improvement of echocardiographic parameters during the study period (i.e., their Δ between preoperative and 5-year measurements); [3] the quantification of how many standard deviations (SD) PMA reduced adverse outcomes.
Results: IPD was the only independent predictor of recurrent moderate to severe MR (OR 10.55, 95% CI 0.61 | 1.33), when adjusted for α and β angles, tenting area, and LVEDD. PMA correlated to an amelioration of α (ρ -0.85) and β (ρ -0.87) angles, pulmonary systolic arterial pressure (ρ -0.44), recurrent MR (ρ -0.32), tenting area (ρ -0.76), left ventricular ejection fraction (ρ +0.56) and end-systolic diameter (ρ -0.67) (p <0.01 for all). PMA reduced the recurrence of MR of 1.91 SD (95% CI -2.28|-1.54), re-hospitalization for heart failure of 2.61 SD (95% CI -2.99|-2.22), reoperation of 2.64 SD (95% CI -3.04|-2.60) cardiac mortality of 2.9 SD (95% CI -3.30|-2.49), and overall mortality of 3.34 SD (95% CI –3.78|-2.90). The results are further detailed in the Figure.
Conclusions: At 5-years follow-up, recurrent IMR is independently predicted by IPD and not by LVEDD. If IPD is surgically stabilized, progressive LVEDD enlargement does not associate with recurrent IMR.
Methods: Ninety-six patient with severe IMR were randomized 1:1 for reduction annuloplasty (RA) vs RA + papillary muscle approximation (PMA). At 5 years follow-up, we evaluated: [1] the association of echocardiographic predictors to recurrent IMR (i.e., moderate-severe MR ± reoperation); [2] the correlation of PMA with an improvement of echocardiographic parameters during the study period (i.e., their Δ between preoperative and 5-year measurements); [3] the quantification of how many standard deviations (SD) PMA reduced adverse outcomes.
Results: IPD was the only independent predictor of recurrent moderate to severe MR (OR 10.55, 95% CI 0.61 | 1.33), when adjusted for α and β angles, tenting area, and LVEDD. PMA correlated to an amelioration of α (ρ -0.85) and β (ρ -0.87) angles, pulmonary systolic arterial pressure (ρ -0.44), recurrent MR (ρ -0.32), tenting area (ρ -0.76), left ventricular ejection fraction (ρ +0.56) and end-systolic diameter (ρ -0.67) (p <0.01 for all). PMA reduced the recurrence of MR of 1.91 SD (95% CI -2.28|-1.54), re-hospitalization for heart failure of 2.61 SD (95% CI -2.99|-2.22), reoperation of 2.64 SD (95% CI -3.04|-2.60) cardiac mortality of 2.9 SD (95% CI -3.30|-2.49), and overall mortality of 3.34 SD (95% CI –3.78|-2.90). The results are further detailed in the Figure.
Conclusions: At 5-years follow-up, recurrent IMR is independently predicted by IPD and not by LVEDD. If IPD is surgically stabilized, progressive LVEDD enlargement does not associate with recurrent IMR.
Mitral Conclave:
Mitral Repair Techniques & Strategies
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