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Mitral valve surgery for acute papillary muscle rupture following myocardial infarction

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), pp. 27-31.

Record type: Article


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


Local EPrints ID: 25364
ISSN: 0966-8519
PURE UUID: 3e174197-b140-4c8b-930e-9bc3cb49ccbf

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Date deposited: 12 Apr 2006
Last modified: 17 Jul 2017 16:11

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Author: Q. Chen
Author: M.J. Rlymple-Hay
Author: C. Alexiou
Author: S.K. Ohri
Author: M.P. Haw
Author: S.A. Livesey
Author: J.L. Monro

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