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Start Over Author "Antona C" Publisher oxford university press (oup)
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18. Surgical treatment for post-infarction papillary muscle rupture: a multicentre study

Author

Bart Meyns, Francesco Formica, Matteo Matteucci, Vittoria Lodo, Federica Torchio, Cinzia Trumello, Adam Kowalówka, Arjang Ruhparwar, Peyman Sardari Nia, Jurij M. Kalisnik, Massimiliano Carrozzini, Daniele Ronco, Giovanni Troise, Guglielmo Mario Actis Dato, Mariusz Kowalewski, Carlo Fino, Giulio Massimi, Stefano D'Alessandro, Theodor Fischlein, Giosuè Falcetta, Carlo Antona, Caterina Simon, Cesare Beghi, Matteo Pettinari, Roberto Scrofani, Claudio Russo, Valeria Lo Coco, Michele De Bonis, Emmanuel Villa, Marek A. Deja, Roberto Lorusso, Shabir Hussain Shah, Igor Vendramin, Sandro Sponga, Fareed A Khouqeer, Matthias Thielmann, Andrea Colli, Massimi, G., Ronco, D., De Bonis, M., Kowalewski, M., Formica, F., Russo, C. F., Sponga, S., Vendramin, I., Falcetta, G., Fischlein, T., Troise, G., Trumello, C., Actis Dato, G., Carrozzini, M., Shah, S. H., Coco, V. L., Villa, E., Scrofani, R., Torchio, F., Antona, C., Kalisnik, J. M., D'Alessandro, S., Pettinari, M., Sardari Nia, P., Lodo, V., Colli, A., Ruhparwar, A., Thielmann, M., Meyns, B., Khouqeer, F. A., Fino, C., Simon, C., Kowalowka, A., Deja, M. A., Beghi, C., Matteucci, M., Lorusso, R., CTC, RS: Carim - V04 Surgical intervention, MUMC+: MA Alg Ond Onderz CTC (9), and MUMC+: MA Med Staf Spec CTC (9)

Subjects
Pulmonary and Respiratory Medicine, ACUTE MYOCARDIAL-INFARCTION, medicine.medical_specialty, medicine.medical_treatment, Medizin, Myocardial Infarction, Mitral valve surgery, MITRAL-VALVE SURGERY, REGURGITATION, law.invention, law, Cardiopulmonary bypass, Clinical endpoint, Humans, Medicine, Hospital Mortality, Myocardial infarction, Coronary Artery Bypass, Acute mitral regurgitation, Papillary muscle rupture, Aged, Papillary Muscles, Mitral Valve Insufficiency, REPAIR, business.industry, Mortality rate, Mitral valve replacement, General Medicine, Odds ratio, medicine.disease, Surgery, REPLACEMENT, Concomitant, SURVIVAL, Cardiology and Cardiovascular Medicine, Complication, business
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.

Published
2021
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