“Papillary heads optimization” for more geometric repair of functional mitral regurgitation toward ventricular treatment

In the era of structural heart disease where catheter-based treatment is prevailing, surgery may have a unique role. For example, surgery may be potentially advantageous in functional mitral regurgitation (FMR), a ventricular disease that not only needs valvular treatment but also requires a ventricular intervention. Being stimulated by the innovative work by Kron et al. (1), we reported anterior relocation of papillary muscles and showed that it improves LV function and FMR (2,3). The revised version [i.e., papillary heads optimization (PHO)] can ameliorate tethering of both anterior and posterior leaflets (4). Since PHO surgery is a little complex, here we provide information of safeguards and pitfalls.