PMID- 37376817 OWN - NLM STAT- MEDLINE DCOM- 20230830 LR - 20230830 IS - 1468-201X (Electronic) IS - 1355-6037 (Linking) VI - 109 IP - 18 DP - 2023 Aug 24 TI - Subannular repair in secondary mitral regurgitation with restricted leaflet motion during systole. PG - 1394-1400 LID - 10.1136/heartjnl-2022-322239 [doi] AB - OBJECTIVE: Ventricular secondary mitral regurgitation (SMR) (Carpentier type IIIb) results from left ventricular (LV) remodelling, displacement of papillary muscles and tethering of mitral leaflets. The most appropriate treatment approach remains controversial. We aimed to assess the safety and efficacy of standardised relocation of both papillary muscles (subannular repair) at 1-year follow-up (FU). METHODS: REFORM-MR (Reform-Mitral Regurgitation) is a prospective, multicentre registry that enrolled consecutive patients with ventricular SMR (Carpentier type IIIb) undergoing standardised subannular mitral valve (MV) repair in combination with annuloplasty at five sites in Germany. Here, we report survival, freedom from recurrence of MR >2+, freedom from major adverse cardiac and cerebrovascular events (MACCEs), including cardiovascular death, myocardial infarction, stroke, MV reintervention and echocardiographic parameters of residual leaflet tethering at 1-year FU. RESULTS: A total of 94 patients (69.1% male) with a mean age of 65.1+/-9.7 years met the inclusion criteria. Advanced LV dysfunction (mean left ventricular ejection fraction 36.4+/-10.5%) and severe LV dilatation (mean left ventricular end-diastolic diameter 61.0+/-9.3 mm) resulted in severe mitral leaflet tethering (mean tenting height 10.6+/-3.0 mm) and an elevated mean EURO Score II of 4.8+/-4.6 prior to surgery. Subannular repair was successfully performed in all patients, without operative mortality or complications. One-year survival was 95.5%. At 12 months, a durable reduction of mitral leaflet tethering resulted in a low rate (4.2%) of recurrent MR >2+. In addition to a significant improvement in New York Heart Association (NYHA) class (22.4% patients in NYHA III/IV vs 64.5% patients at baseline, p<0.001), freedom from MACCE was observed in 91.1% of patients. CONCLUSIONS: Our study demonstrates the safety and feasibility of standardised subannular repair to treat ventricular SMR (Carpentier type IIIb) in a multicentre setting. By addressing mitral leaflet tethering, papillary muscle relocation results in very satisfactory 1-year outcomes and has the potential to durably restore MV geometry; nevertheless, long-term FU is mandatory. TRIAL REGISTRATION NUMBER: NCT03470155. CI - (c) Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ. FAU - Pausch, Jonas AU - Pausch J AUID- ORCID: 0000-0002-7418-1815 AD - Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany j.pausch@uke.de. FAU - Harmel, Eva AU - Harmel E AD - I. Medical Clinic, University Hospital Augsburg, Augsburg, Germany. FAU - Reichenspurner, Hermann AU - Reichenspurner H AD - Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany. AD - German Center for Cardiovascular Research, Partner Site Hamburg/Lubeck/Kiel, Hamburg, Germany. FAU - Kempfert, Jorg AU - Kempfert J AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. AD - German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany. FAU - Kuntze, Thomas AU - Kuntze T AD - Department of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, Germany. FAU - Owais, Tamer AU - Owais T AD - Department of Cardiovascular and Thoracic Surgery, University Hospital Augsburg, Augsburg, Germany. FAU - Holubec, Tomas AU - Holubec T AUID- ORCID: 0000-0003-2366-0880 AD - Department of Cardiovascular Surgery, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany. FAU - Walther, Thomas AU - Walther T AD - Department of Cardiovascular Surgery, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Hessen, Germany. AD - German Center for Cardiovascular Research, Partner Site Rhine-Main, Frankfurt, Germany. FAU - Krane, Markus AU - Krane M AD - Department of Cardiac Surgery, German Heart Center Munich, Munchen, Germany. AD - Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA. FAU - Vitanova, Keti AU - Vitanova K AD - Department of Cardiac Surgery, German Heart Center Munich, Munchen, Germany. FAU - Borger, Michael Andrew AU - Borger MA AD - University Clinic of Cardiac Surgery, Leipzig Heart Centre, Leipzig, Germany. FAU - Eden, Matthias AU - Eden M AD - Department for Internal Medicine, University Hospital Heidelberg, Heidelberg, Germany. FAU - Hachaturyan, Violetta AU - Hachaturyan V AD - Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany. FAU - Bramlage, Peter AU - Bramlage P AD - Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany. FAU - Falk, Volkmar AU - Falk V AD - Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany. AD - German Center for Cardiovascular Research, Partner Site Berlin, Berlin, Germany. AD - Department of Cardiovascular Surgery, Charite - Universitatsmedizin Berlin, Berlin, Germany. AD - Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland. FAU - Girdauskas, Evaldas AU - Girdauskas E AD - Department of Cardiovascular Surgery, University Medical Center Hamburg-Eppendorf University Heart & Vascular Center, Hamburg, Germany. AD - German Center for Cardiovascular Research, Partner Site Hamburg/Lubeck/Kiel, Hamburg, Germany. AD - Department of Cardiovascular and Thoracic Surgery, University Hospital Augsburg, Augsburg, Germany. LA - eng SI - ClinicalTrials.gov/NCT03470155 PT - Clinical Trial PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't DEP - 20230824 PL - England TA - Heart JT - Heart (British Cardiac Society) JID - 9602087 SB - IM CIN - Heart. 2023 Aug 24;109(18):1348-1349. PMID: 37258096 MH - Aged MH - Female MH - Humans MH - Male MH - Middle Aged MH - *Mitral Valve Annuloplasty/adverse effects/methods MH - *Mitral Valve Insufficiency/diagnostic imaging/etiology/surgery MH - Prospective Studies MH - Stroke Volume MH - Systole MH - Treatment Outcome MH - Ventricular Function, Left OTO - NOTNLM OT - cardiomyopathies OT - heart failure, systolic OT - mitral valve insufficiency COIS- Competing interests: None declared. EDAT- 2023/06/28 06:42 MHDA- 2023/08/28 06:42 CRDT- 2023/06/28 02:53 PHST- 2022/12/07 00:00 [received] PHST- 2023/03/02 00:00 [accepted] PHST- 2023/08/28 06:42 [medline] PHST- 2023/06/28 06:42 [pubmed] PHST- 2023/06/28 02:53 [entrez] AID - heartjnl-2022-322239 [pii] AID - 10.1136/heartjnl-2022-322239 [doi] PST - epublish SO - Heart. 2023 Aug 24;109(18):1394-1400. doi: 10.1136/heartjnl-2022-322239.