Sub-annular procedures for secondary mitral valve regurgitation.
Abstract
Restrictive mitral valve annuloplasty is the worldwide used technique to
treat secondary mitral valve regurgitation. This procedure is still
associated with high rate of recurrent mitral valve regurgitation at 1
year follow-up. In the last 2 decades, several investigators proposed
different surgical techniques to add to mitral valve annuloplasty to
improve the long-term repair results in secondary mitral valve
regurgitation. Papillary muscle (PPM) relocation technique aimed to
reduce the distance between the head of PPM and the mitral annulus to
relieve leaflets tethering and improve coaptation. Chordal cutting
procedure consist in cutting a limited number of basal chordae to
improve systolic leaflet motion and coaptation and reduce leaflets
tethering; eliminating secondary chordae in the anterior leaflet can
allow the leaflets to assume a more normal and less taut configuration,
with more effective coaptation at their free margin. Chordal cutting and
transfer procedure was proposed to maintain the continuity between the
mitral apparatus and the left ventricle. PPM sling or approximation
technique is performed using prolene suture reinforced with pleagets to
joint bot papillary muscles; this technique reduce the muscles
displacement and improve systolic coaptation. Several papers showed the
superiority of the adjunction subannular procedure up to isolated
restrictive annuloplasty in term of outcomes .