Is subvalvular repair worthwhile in severe ischemic mitral regurgitation? Subanalysis of the Papillary Muscle Approximation trial Francesco Nappi, MD,

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Presentation transcript:

Is subvalvular repair worthwhile in severe ischemic mitral regurgitation? Subanalysis of the Papillary Muscle Approximation trial Francesco Nappi, MD, Cristiano Spadaccio, MD, PhD, Antonio Nenna, MD, Mario Lusini, MD, PhD, Massimiliano Fraldi, PhD, Christophe Acar, MD, Massimo Chello, MD The Journal of Thoracic and Cardiovascular Surgery Volume 153, Issue 2, Pages 286-295.e2 (February 2017) DOI: 10.1016/j.jtcvs.2016.09.050 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Papillary muscle approximation procedure depending on surgical anatomy of papillary muscles: anatomy type 1 or 2 (A), or type 3, 4, or 5 (B). The Journal of Thoracic and Cardiovascular Surgery 2017 153, 286-295.e2DOI: (10.1016/j.jtcvs.2016.09.050) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Change from baseline in echocardiographic characteristics depending on symmetry of tethering (A) or regional wall motion abnormality (B). *Difference is statistically significant with P < .05. LVEDD, Left ventricular end-diastolic diameter; LVESD, left ventricular end-systolic diameter; LVEF, left ventricular ejection fraction; S, symmetric tethering; A, asymmetric tethering; I, inferior; IP, inferoposterior; AL, anterolateral. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 286-295.e2DOI: (10.1016/j.jtcvs.2016.09.050) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E1 Overall mortality in patients with symmetric tethering (A) and asymmetric tethering (B). The Journal of Thoracic and Cardiovascular Surgery 2017 153, 286-295.e2DOI: (10.1016/j.jtcvs.2016.09.050) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E2 Freedom from reoperation in patients with symmetric tethering (A) and asymmetric tethering (B). The Journal of Thoracic and Cardiovascular Surgery 2017 153, 286-295.e2DOI: (10.1016/j.jtcvs.2016.09.050) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure E3 Freedom from composite cardiac endpoint in patients with symmetric tethering (A) and asymmetric tethering (B). The Journal of Thoracic and Cardiovascular Surgery 2017 153, 286-295.e2DOI: (10.1016/j.jtcvs.2016.09.050) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Papillary muscle approximation. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 286-295.e2DOI: (10.1016/j.jtcvs.2016.09.050) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Animation showing the rationale and basic principles of papillary muscle approximation. The video also explains some surgical technicalities inherent in the surgical procedure according to the variability of papillary muscle morphology and anatomy. Video available at: http://www.jtcvsonline.org/article/S0022-5223(16)31168-0/addons. The Journal of Thoracic and Cardiovascular Surgery 2017 153, 286-295.e2DOI: (10.1016/j.jtcvs.2016.09.050) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions