Extracorporeal life support in mitral papillary muscle rupture: Outcome of multicenter study

Abstract

BackgroundPost‐acute myocardial infarction papillary muscle rupture (post‐AMI PMR) may present variable clinical scenarios and degree of emergency due to result of cardiogenic shock. Veno‐arterial extracorporeal life support (V‐A ECLS) has been proposed to improve extremely poor pre‐ or postoperative conditions. Information in this respect is scarce.MethodsFrom the CAUTION (meChanical complicAtion of acUte myocardial infarcTion: an InternatiOnal multiceNter cohort study) database (16 different Centers, data from 2001 to 2018), we extracted adult patients who were surgically treated for post‐AMI PMR and underwent pre‐ or/and postoperative V‐A ECLS support. The end‐points of this study were in‐hospital survival and ECLS complications.ResultsFrom a total of 214 post‐AMI PMR patients submitted to surgery, V‐A ECLS was instituted in 23 (11%) patients. The median age was 61.7 years (range 46–81 years). Preoperatively, ECLS was commenced in 10 patients (43.5%), whereas intra/postoperative in the remaining 13. The most common V‐A ECLS indication was post‐cardiotomy shock, followed by preoperative cardiogenic shock and cardiac arrest. The median duration of V‐A ECLS was 4 days. V‐A ECLS complications occurred in more than half of the patients. Overall, in‐hospital mortality was 39.2% (9/23), compared to 22% (42/219) for the non‐ECLS group.ConclusionsIn post‐AMI PMR patients, V‐A ECLS was used in almost 10% of the patients either to promote bridge to surgery or as postoperative support. Further investigations are required to better evaluate a potential for increased use and its effects of V‐A ECLS in such a context based on the still high perioperative mortality.

The use of veno-veno-arterial ECMO as a successful strategy in acute mitral regurgitation secondary to papillary muscle rupture causing cardiogenic shock and profound hypoxemia: a case report

“…Acute MR secondary to PMR is a rare mechanical complication of acute MI with an incidence of 0.05–0.26% [ 1 ]. The definite treatment remains emergency mitral surgery with a high operative mortality (24–39%) [ 2 , 3 ].…”

“…The largest study on the use of VA ECMO in PMR was a retrospective analysis of multicenter registry (the CAUTION study) [ 1 ]. The authors reported on 23 patients that required VA ECMO support (with 43.5% of patients requiring it preoperatively).…”

Left ventricular unloading therapy using Impella 5.5 after emergency surgery for acute myocardial infarction mechanical complication: a case report

“…Left ventricular free wall rupture (LVFWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) after acute myocardial infarction (AMI) are potentially fatal pathologies. Cardiac surgery for these mechanical complications of AMI has a high in-hospital mortality rate, which has not improved significantly over time [1][2][3]. Left ventricular (LV) unloading is essential to avoid excessive tension on the repair site after emergency surgery, which leads to burdensome hemostasis of the LV wall, a residual leak, patch dehiscence, and recurrence of LVFWR and VSR.…”