Formula-Based Relocation of the Papillary Muscle in Patients With Ischemic Mitral Regurgitation

<h2>Abstract</h2><h3>Background</h3> We developed a formula to estimate the optimal distance between the posterior papillary muscle (PPM) and the midseptal fibrous annulus (D_P-A) to facilitate PPM relocation in patients with ischemic mitral regurgitation (IMR) undergoing mitral valve repair. <h3>Methods</h3> D_P-A was measured in 109 patients without valvular disease undergoing electrocardiogram-gated 3-dimensional computed tomography, and a predictive formula that best approximated this value was developed. This formula was evaluated in 10 patients (59.2 [SD, 10.7] years, 7 men) with moderate-severe IMR undergoing mitral valve repair using PPM relocation by 3 surgeons in 6 institutions from 2014 to 2023. Two arms of CV-3 suture fixed at the PPM were passed through the midseptal fibrous annulus to the annuloplasty ring and tied at the length estimated using the formula (35 [SD, 4] mm). <h3>Results</h3> Postoperative echocardiography demonstrated neither residual regurgitation nor leaflet tenting. Three patients died and 1 underwent mitral valve replacement during follow-up (71 [SD, 35] months), but IMR was well controlled, and left ventricular reverse remodeling and improved left ventricular function was observed in the other 6. <h3>Conclusions</h3> This formula facilitates mitral valve repair using PPM relocation in patients with IMR.