{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:51:13Z","timestamp":1753876273810,"version":"3.41.2"},"reference-count":25,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2019,7,31]],"date-time":"2019-07-31T00:00:00Z","timestamp":1564531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title><jats:p\/><jats:sec><jats:title>OBJECTIVES:<\/jats:title><jats:p>Functional mitral regurgitation (FMR) in patients with non-ischaemic dilative cardiomyopathy (DCM) is associated with heart failure and poor outcome. Aggressively undersized annuloplasty as an annular solution for a ventricular problem ameliorates heart failure but may be associated with recurrent FMR and does not improve survival. We sought to analyse if moderately undersized annuloplasty with repositioning of both papillary muscles can lead to improved valve stability and outcome in patients with DCM and FMR.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS:<\/jats:title><jats:p>In 66 patients with DCM-associated FMR (age 66\u2009\u00b1\u200912\u2009years, ejection fraction 29\u2009\u00b1\u20096% and mean pulmonary artery pressure 35\u2009\u00b1\u200911\u2009mmHg) and severe leaflet tethering (tenting height \u226510\u2009mm) bilateral papillary muscle repositioning was added to moderately undersized ring annuloplasty (median size 30\u2009mm). Concomitant surgery included tricuspid valve repair in 86% of patients and atrial ablation in 44%.<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS:<\/jats:title><jats:p>The early mortality rate was 9%. Overall 5-year freedom from all-cause death, left ventricular assist device implantation or heart transplant was 58% (95% confidence interval 45\u201371%). Six patients underwent reoperation (redo repair n\u2009=\u20094). Reverse remodelling was observed during follow-up in 66% of patients with decreasing left ventricular end-diastolic diameters (66\u2009\u00b1\u20095 to 61\u2009\u00b1\u200912\u2009mm; P\u2009&lt;\u20090.001) and left ventricular end-systolic diameters (56\u2009\u00b1\u20099 to 51\u2009\u00b1\u200914\u2009mm; P\u2009=\u20090.001). Subgroup analyses (partial versus complete ring, preoperative left ventricular end-diastolic diameters &lt;65\u2009mm vs left ventricular end-diastolic diameter \u226565\u2009mm) documented similar survival rates. A competing risks regression analysis identified cerebral vascular disease (P\u2009=\u20090.01), use of a partial ring (P\u2009=\u20090.03) and absence of tricuspid valve repair (P\u2009=\u20090.03) as independent predictors of death.<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS:<\/jats:title><jats:p>The combination of bilateral papillary muscle repositioning and moderately undersized ring annuloplasty leads to stable mid-term repair results and reverse remodelling in patients with DCM and FMR and severe leaflet tethering.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ejcts\/ezz204","type":"journal-article","created":{"date-parts":[[2019,7,9]],"date-time":"2019-07-09T19:09:09Z","timestamp":1562699349000},"source":"Crossref","is-referenced-by-count":0,"title":["Bilateral papillary muscle repositioning: successful repair of functional mitral regurgitation in dilative cardiomyopathy"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5817-0545","authenticated-orcid":false,"given":"Frank","family":"Langer","sequence":"first","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6903-6501","authenticated-orcid":false,"given":"Takashi","family":"Kunihara","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, Jikei University School of Medicine, Minato-Ku, Tokyo, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shunsuke","family":"Miyahara","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9827-993X","authenticated-orcid":false,"given":"Lisa","family":"Fahrig","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Bl\u00fcmel","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Annika","family":"Kl\u00e4r","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Raddatz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care Medicine, Saarland University Medical Center, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irem","family":"Karliova","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abdelshafi","family":"Bekhit","sequence":"additional","affiliation":[{"name":"Institute for Medical Biometry, Epidemiology & Medical Informatics, Saarland University Medical Center, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H -J","family":"Sch\u00e4fers","sequence":"additional","affiliation":[{"name":"Department of Thoracic and Cardiovascular Surgery, Saarland University Medical Center, Homburg\/Saar, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2019,7,31]]},"reference":[{"key":"2019073106103866900_ezz204-B1","doi-asserted-by":"crossref","first-page":"1675","DOI":"10.1136\/hrt.2011.225789","article-title":"Independent prognostic value of functional mitral regurgitation in patients with heart failure. 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