Is Subvalvular Repair Worthwhile in Severe Ischemic Mitral Regurgitation? (from the Papillary Muscle Approximation trial)

The authors performed a subgroup analysis of the Papillary Muscle Approximation (PMA) trial, a randomized trial that, while showing superiority of PMA + restrictive annuloplasty (RA) over RA alone in terms of LV remodeling and MR recurrence, failed to show a survival advantage and was plagued by a relatively high incidence of reoperation.  In this study, the authors found that the best outcomes were seen in patients with preop symmetric tethering, asymmetric tethering, or inferior wall dyskinesia.  Patients with primarily anterolateral wall dysfunction did not benefit from the addition of the PMA.