Surgical treatment for post-infarction papillary muscle rupture: a multicentre study

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[Released on 08/10/2021]

Authors: Giulio Massimi, , Daniele Ronco, , Michele De Bonis, , Mariusz Kowalewski, , Francesco Formica, , Claudio Francesco Russo, , Sandro Sponga, , Igor Vendramin, , Giosuè Falcetta, , Theodor Fischlein, , Giovanni Troise, , Cinzia Trumello, , Guglielmo Actis Dato, , Massimiliano Carrozzini, , Shabir Hussain Shah, , Valeria Lo Coco, , Emmanuel Villa, , Roberto Scrofani, , Federica Torchio, , Carlo Antona, , Jurij Matija Kalisnik, , Stefano D’Alessandro, , Matteo Pettinari, , Peyman Sardari Nia, , Vittoria Lodo, , Andrea Colli, , Arjang Ruhparwar, , Matthias Thielmann, , Bart Meyns, , Fareed A Khouqeer, , Carlo Fino, , Caterina Simon, , Adam Kowalowka, , Marek A Deja, , Cesare Beghi, , Matteo Matteucci, , Roberto Lorusso

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.

Keywords: Papillary muscle rupture, Mitral valve surgery, Acute mitral regurgitation

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Surgical treatment for post-infarction papillary muscle rupture: a multicentre study

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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.

Keywords: Papillary muscle rupture, Mitral valve surgery, Acute mitral regurgitation

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