Girdauskas Evaldas, Stock Sina, Favot Elisa, Luani Blerim, Sequeira-Gross Tatiana, Dumps Christian, von Stumm Maria, Owais Tamer, von Scheidt Wolfgang
Department of Cardiothoracic Surgery, University Hospital Augsburg, 86150 Augsburg, Germany.
Department of Cardiology, Hospital Ingolstadt, 85049 Ingolstadt, Germany.
Rev Cardiovasc Med. 2024 Aug 9;25(8):283. doi: 10.31083/j.rcm2508283. eCollection 2024 Aug.
The treatment of secondary mitral regurgitation (SMR) remains challenging despite the implementation of modern heart failure medication and established catheter-based techniques. Only a subgroup of SMR patients benefit from mitral valve (MV) intervention, and the long-term prognostic benefit of different therapeutic approaches in SMR remains controversial. A literature search was conducted through PubMed and Embase databases to identify relevant studies addressing the pathophysiological background for papillary muscle maneuvers in SMR and currently available surgical techniques. Furthermore, the studies evaluating patients' selection criteria for papillary muscle maneuvers were specifically considered. Articles were selected based on quality and relevance. Over the last two decades, papillary muscle maneuvers have evolved as a pathophysiology-based treatment strategy to address left ventricular (LV) remodeling in SMR. In particular, patients with severe leaflet tenting and moderate heart failure phenotype seem to benefit most from papillary muscle maneuvers that improve LV geometry and thereby the durability of MV repair. We conclude that papillary muscle maneuvers are an evolving pathophysiology-based treatment strategy of ventricular SMR which target papillary muscle displacement due to LV remodeling.
尽管现代心力衰竭药物治疗和成熟的导管技术已得到应用，但继发性二尖瓣反流（SMR）的治疗仍然具有挑战性。只有一小部分SMR患者能从二尖瓣（MV）干预中获益，不同治疗方法对SMR的长期预后益处仍存在争议。通过PubMed和Embase数据库进行文献检索，以确定涉及SMR中乳头肌操作的病理生理背景及当前可用手术技术的相关研究。此外，还特别考虑了评估乳头肌操作患者选择标准的研究。根据质量和相关性选择文章。在过去二十年中，乳头肌操作已发展成为一种基于病理生理学的治疗策略，用于解决SMR中的左心室（LV）重塑问题。特别是，伴有严重瓣叶帐篷样改变和中度心力衰竭表型的患者似乎从改善LV几何形状从而提高MV修复耐久性的乳头肌操作中获益最大。我们得出结论，乳头肌操作是一种不断发展的基于病理生理学的心室SMR治疗策略，其针对因LV重塑导致的乳头肌移位。
