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Mitral valve surgery for acute papillary muscle rupture following myocardial infarction

Mitral valve surgery for acute papillary muscle rupture following myocardial infarction
Mitral valve surgery for acute papillary muscle rupture following myocardial infarction
BACKGROUND AND AIM OF THE STUDY: Acute papillary muscle rupture (PMR) is a rare but fatal complication of myocardial infarction (MI). Surgery represents the best treatment option, but carries a high risk. Our experience of emergency mitral valve surgery in patients with acute PMR following MI during the past 22 years is reviewed.
METHODS: Between 1978 and 2000, 33 patients (20 males, 13 females; mean age 64 years; range: 46-80) underwent emergency surgery for acute post-infarct PMR in our institution. The site of MI was anterior in three patients and inferior in 30. Preoperatively, 17 patients had an intra-aortic balloon pump (IABP) inserted, 26 were on inotropic support, and 17 were ventilated. Twenty patients (61%) underwent concomitant coronary bypass grafting (CABG). The valve was replaced in 31 patients and repaired in two. Mean (+/- SD) duration of follow up was 63+/-54 months (range: 0-183 months).
RESULTS: Early mortality (in-hospital) was 21% (n = 7). Factors associated with significant risk of early mortality included raised preoperative serum creatinine (p = 0.02), need for preoperative inotropic support (p = 0.03) and preoperative ventilation (p = 0.03). Raised preoperative serum creatinine remained significant on multiple logistic regression (p = 0.04). Postoperatively, 21 patients required an IABP. Mean duration of intensive care unit stay was 4+/-2.5 days (range: 0-10 days). Survival, including in-hospital mortality, at one, five and 10 years was 75+/-7.4, 65+/-8.6 and 32+/-9.7%, respectively. Four patients required valve-related reoperation (three for a paraprosthetic leak, one for failed repair).
CONCLUSION: Patients with acute post-infarct PMR present in a severely compromised state. Early mortality is high, but the intermediate outcome is encouraging for operative survivors.
0966-8519
27-31
Chen, Q.
dd95839a-6c50-4287-b5d6-1d87c949db2b
Rlymple-Hay, M.J.
f315c961-7b78-4509-b42b-351fe7f3f0c3
Alexiou, C.
cb234ab6-eef6-4366-be16-803c0dbc9d0c
Ohri, S.K.
8aa5698c-78cf-4f59-a5af-5afa46f0348c
Haw, M.P.
2b6001b8-3b36-4408-a185-322bbdd6e730
Livesey, S.A.
58bd365f-08a5-4420-9d47-89097a21d0ee
Monro, J.L.
cfbae9db-85f1-4845-93a0-9d0c1413c4df
Chen, Q.
dd95839a-6c50-4287-b5d6-1d87c949db2b
Rlymple-Hay, M.J.
f315c961-7b78-4509-b42b-351fe7f3f0c3
Alexiou, C.
cb234ab6-eef6-4366-be16-803c0dbc9d0c
Ohri, S.K.
8aa5698c-78cf-4f59-a5af-5afa46f0348c
Haw, M.P.
2b6001b8-3b36-4408-a185-322bbdd6e730
Livesey, S.A.
58bd365f-08a5-4420-9d47-89097a21d0ee
Monro, J.L.
cfbae9db-85f1-4845-93a0-9d0c1413c4df

Chen, Q., Rlymple-Hay, M.J., Alexiou, C., Ohri, S.K., Haw, M.P., Livesey, S.A. and Monro, J.L. (2002) Mitral valve surgery for acute papillary muscle rupture following myocardial infarction. The Journal of Heart Valve Disease, 11 (1), 27-31.

Record type: Article

Abstract

BACKGROUND AND AIM OF THE STUDY: Acute papillary muscle rupture (PMR) is a rare but fatal complication of myocardial infarction (MI). Surgery represents the best treatment option, but carries a high risk. Our experience of emergency mitral valve surgery in patients with acute PMR following MI during the past 22 years is reviewed.
METHODS: Between 1978 and 2000, 33 patients (20 males, 13 females; mean age 64 years; range: 46-80) underwent emergency surgery for acute post-infarct PMR in our institution. The site of MI was anterior in three patients and inferior in 30. Preoperatively, 17 patients had an intra-aortic balloon pump (IABP) inserted, 26 were on inotropic support, and 17 were ventilated. Twenty patients (61%) underwent concomitant coronary bypass grafting (CABG). The valve was replaced in 31 patients and repaired in two. Mean (+/- SD) duration of follow up was 63+/-54 months (range: 0-183 months).
RESULTS: Early mortality (in-hospital) was 21% (n = 7). Factors associated with significant risk of early mortality included raised preoperative serum creatinine (p = 0.02), need for preoperative inotropic support (p = 0.03) and preoperative ventilation (p = 0.03). Raised preoperative serum creatinine remained significant on multiple logistic regression (p = 0.04). Postoperatively, 21 patients required an IABP. Mean duration of intensive care unit stay was 4+/-2.5 days (range: 0-10 days). Survival, including in-hospital mortality, at one, five and 10 years was 75+/-7.4, 65+/-8.6 and 32+/-9.7%, respectively. Four patients required valve-related reoperation (three for a paraprosthetic leak, one for failed repair).
CONCLUSION: Patients with acute post-infarct PMR present in a severely compromised state. Early mortality is high, but the intermediate outcome is encouraging for operative survivors.

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Published date: 2002

Identifiers

Local EPrints ID: 25364
URI: http://eprints.soton.ac.uk/id/eprint/25364
ISSN: 0966-8519
PURE UUID: 3e174197-b140-4c8b-930e-9bc3cb49ccbf

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Date deposited: 12 Apr 2006
Last modified: 15 Jul 2019 19:16

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