Mitral Valve Surgery for Papillary Muscle Rupture: Outcomes in 1342 Patients From The Society of Thoracic Surgeons Database

Background Prior reports of mitral valve surgery (MVS) for ischemic papillary muscle rupture (PMR) have been limited in patient numbers. This study evaluated national outcomes of MVS for PMR using the Society of Thoracic Surgeons (STS) National Database. Methods The study cohort was comprised of patients undergoing MVS for ischemic PMR between 2011 to 2018 in the STS registry. Concomitant procedures were included. The primary outcome was operative mortality. Secondary outcomes included STS major morbidities. Multivariable logistic regression was used for risk-adjustment using clinically important variables as well as those predictive in univariate analysis. Results 1,342 patients underwent MVS for PMR during the study period. The majority of these were mitral valve replacements (79.8%; n=1,071) and were performed emergently (52.0%; n=698). Concomitant coronary artery bypass grafting (CABG) was performed in 59.3% (n=796). Mechanical circulatory assistance prior to MVS included intra-aortic balloon pump (56.9%; n=764), Impella (4.1%; n=55), and extracorporeal membrane oxygenation (3.1%; n=41). STS predicted risk of mortality was 16.9% ± 15.4%. Operative mortality was 20.0%. Blood products were transfused in 70.7% (n=949). Major morbidity rates included prolonged ventilation (61.8%; n=829), acute renal failure (15.4%; n=206), reoperation (10.2%; n=137), and stroke (5.2%; n=70). Multivariable predictors of operative mortality included mitral valve replacement, older age, lower albumin, cardiogenic shock, ejection fraction Conclusions These data provide a national overview of outcomes following MVS for PMR. Rates of mortality and morbidity are high but the majority of patients survive operative intervention in this high-risk and otherwise lethal condition.