Surgical treatment for post-infarction papillary muscle rupture: a multicentre study. (31st October 2021)

• Record Type: Journal Article
• Authors: Massimi, Giulio; Ronco, Daniele; De Bonis, Michele; Kowalewski, Mariusz; Formica, Francesco; Russo, Claudio Francesco; Sponga, Sandro; Vendramin, Igor; Falcetta, Giosuè; Fischlein, Theodor; Troise, Giovanni; Trumello, Cinzia; Actis Dato, Guglielmo; Carrozzini, Massimiliano; Shah, Shabir Hussain; Coco, Valeria Lo; Villa, Emmanuel; Scrofani, Roberto; Torchio, Federica; Antona, Carlo; Kalisnik, Jurij Matija; D'Alessandro, Stefano; Pettinari, Matteo; Sardari Nia, Peyman; Lodo, Vittoria; Colli, Andrea; Ruhparwar, Arjang; Thielmann, Matthias; Meyns, Bart; Khouqeer, Fareed A; Fino, Carlo; Simon, Caterina; Kowalowka, Adam; Deja, Marek A; Beghi, Cesare; Matteucci, Matteo; Lorusso, Roberto;
• Is Part Of: European journal of cardio-thoracic surgery. Volume 61:Number 2(2022)
• Page Start: 469
• Page End: 476
• Publication Date: 2021-10-31
• Subjects: Papillary muscle rupture -- Mitral valve surgery -- Acute mitral regurgitation; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezab469
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: : OBJECTIVES: Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry. METHODS: Patients underwent surgery for post-infarction PMR between 2001 through 2019 were retrieved from database of the CAUTION study . The primary end point was in-hospital mortality. RESULTS: A total of 214 patients were included with a mean age of 66.9 (standard deviation: 10.5) years. The posteromedial papillary muscle was the most frequent rupture location (71.9%); the rupture was complete in 67.3% of patients. Mitral valve replacement was performed in 82.7% of cases. One hundred twenty-two patients (57%) had concomitant coronary artery bypass grafting. In-hospital mortality was 24.8%. Temporal trends revealed no apparent improvement in in-hospital mortality during the study period. Multivariable analysis showed that preoperative chronic kidney disfunction [odds ratio (OR): 2.62, 95% confidence interval (CI): 1.07–6.45, P = 0.036], cardiac arrest (OR: 3.99, 95% CI: 1.02–15.61, P = 0.046) and cardiopulmonary bypass duration (OR: 1.01, 95% CI: 1.00–1.02, P = 0.04) were independently associated with an increased risk of in-hospital death, whereas concomitant coronary artery bypass grafting was identified as an independent predictor of early survival (OR: 0.38, 95% CI: 0.16–0.92, P = 0.031). CONCLUSIONS: Surgical treatment for post-infarction PMR carries a high in-hospital mortality rate, which did not improve during the study period. Because concomitant coronary artery bypass grafting confers a survival benefit, this additional procedure should be performed, whenever possible, in an attempt to improve the outcome. Clinical trial registration: clinicaltrials.gov: NCT03848429. Abstract : Papillary muscle rupture (PMR) is an infrequent but life-threatening mechanical complication (MC) of acute myocardial infarction (AMI) [1].