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Papillary Muscle Head Repositioning for the Treatment of Commissural Prolapse in Degenerative Mitral Valve Disease
Anton Tomsic, Robert J.M. Klautz, Thomas J. van Brakel, Michel I.M. Versteegh, Meindert Palmen.
Leiden University Medical Center, Leiden, Netherlands.

Background:
Surgical correction of commissural mitral valve prolapse can be challenging. Several surgical techniques -including commissural closure, leaflet resection with sliding, and chordae replacement- have been described and results reported. Conversely, the long-term outcome of papillary muscle head repositioning for the treatment of commissural prolapse remains unknown.
Methods:
Between January 2000 and December 2015, 653 patients underwent mitral valve repair for degenerative mitral valve regurgitation at our institution. Among these, 148 patients had non-isolated commissural prolapse (16 anterolateral, 112 posteromedial, and 20 bicommissural prolapse). 106 patients underwent papillary muscle head repositioning and present the study cohort.
Results:
The median patient age was 65.4 (IQR 54.4 - 73.3) and 41 (39%) patients were female. Postoperative echocardiography demonstrated residual mitral regurgitation in 2 patients; 1 underwent early reoperation. The median clinical follow up duration was 9.3 years (IQR 3.7 - 11.2). Five (5%) patients required late mitral valve reintervention, none due to recurrent commissural prolapse. The freedom from late reintervention rate at 5 and 10 years was 96.4% (95% CI 100%- 92.5%) and 93.3% (95% CI 98.9%- 87.6%), respectively. The median echocardiographic follow-up time was 6.4 years (IQR 1.8 - 10.5) and was available in 90% of patients. The freedom from grade 3+ mitral regurgitation rate at 5 and 10 years was 93.9% (95% CI 99.8%- 88.0%) for both.
Conclusions:
Papillary muscle head repositioning for the treatment of commissural mitral valve prolapse is a reproducible and reliable technique that provides excellent long-term results.


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