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

Kilic, Arman; Sultan, Ibrahim; Chu, Danny; Wang, Yisi; Gleason, Thomas G.

doi:10.1016/j.athoracsur.2020.03.097

Cited by 34 publications

(35 citation statements)

References 13 publications

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“…Due to hemodynamic instability and possible cardiogenic shock, patients with PMR may need inotropic or mechanical circulatory support. 14 , 15 However, in a large cohort study, preoperative inotropes and mechanical circulatory support were not associated with better or worse outcomes. 14 In clinical practice, MV surgery should not be delayed, and circulatory support should only be used as a mitigation plan to make the operation possible.…”

Section: Discussionmentioning

confidence: 93%

“…Although the overall incidence of PMR and active IE is low, surgery remains challenging, and morbidity and mortality are relatively high. [2][3][4] Timely diagnosis of acute MR is necessary, and an emergency or urgent operation is often required in patients with PMR caused by acute MI and active IE of the mitral valve. Debate is ongoing over whether MV repair brings any further benefits to patients with these conditions.…”

Section: Introductionmentioning

confidence: 99%

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Outcomes of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis

Wang

Zhou

et al. 2020

Asian Cardiovasc Thorac Ann

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Background Emergency or urgent surgery is often required in patients with papillary muscle rupture and active mitral valve infective endocarditis. The aim of this study was to analyze the outcomes of patients with active endocarditis who underwent emergency or urgent mitral valve repair. Methods From 2005 to 2014, 154 ischemic mitral regurgitation patients and 41 infective endocarditis patients underwent mitral valve repair in our institution; 23 had emergency operations due to papillary muscle rupture, and 18 with active infective endocarditis underwent urgent surgery. Results Cardiopulmonary bypass time (141.4 ± 43.3 versus 145.3 ± 46.5 min) and crossclamp time (77.7 ± 34.1 versus 79.2 ± 33.0 min) were similar in the papillary muscle rupture and elective ischemic mitral regurgitation subgroups, and major postoperative complications were comparable. Hospital mortality was 17.4% in the papillary muscle rupture subgroup and 8.4% in the elective ischemic mitral regurgitation subgroup. Cardiopulmonary bypass time (103.6 ± 37.0 versus 75.5 ± 20.8 min) and crossclamp time (61.7 ± 21.2 versus 45.3 ± 18.0 min) were significantly longer in infective endocarditis patients. There were no major complications or hospital deaths. Eight years postoperatively, overall survival was 94.4% and 86.5% in the papillary muscle rupture and elective ischemic mitral regurgitation subgroups, respectively ( p = 0.730). Overall survival was 100% in both infective endocarditis subgroups. Conclusion The feasibility and effectiveness of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis are satisfactory. Early and mid-term outcomes are comparable to those of elective operations.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Outcomes of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis

Wang

Zhou

et al. 2020

Asian Cardiovasc Thorac Ann

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“…Recently, analysis of the outcomes of mitral valve surgery for PMR from STS database was published [ 20 ]. They analyzed 1342 patients during 8 years in the USA.…”

Section: Discussionmentioning

confidence: 99%

Mitral valve surgery for ischemic papillary muscle rupture: outcomes from the Japan cardiovascular surgery database

Fujita

Yamamoto

Kobayashi

et al. 2020

Gen Thorac Cardiovasc Surg

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Background Ischemic papillary muscle rupture (PMR) is a catastrophic complication following acute myocardial infarction (AMI). We evaluated early outcomes of PMR by using data from the Japan Cardiovascular Surgery Database, a nationwide Japanese registry. Methods We retrospectively analyzed data from 196 patients diagnosed with PMR following AMI in Japan between January 2014 and December 2017. Risk factors for operative mortality and severe complications following mitral valve surgery were analyzed. Results The 30-day and hospital mortality rates were 20% and 26%, respectively. Chronic hemodialysis, abrupt rupture after AMI, resuscitation before surgery, and preoperative venoarterial extracorporeal membrane oxygenation were associated with mortality. Mitral valve replacement was chosen mainly (90%) for surgical correction of mitral regurgitation in these patients. There was no significant difference in short-term outcomes between mitral valve replacement versus mitral valve repair, despite non-matched characteristics in background between the treatment groups. Concomitant coronary artery bypass grafting had no impact on short-term outcomes. Conclusions Information derived from the nationwide database of patients with AMI-associated PMR show that PMR is a rare condition in the modern era. However, PMR is a severe disease with a mortality rate as high as 26%. The severity of the condition is associated with the risk for poor outcomes. Electronic supplementary material The online version of this article (10.1007/s11748-020-01418-y) contains supplementary material, which is available to authorized users.

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“…In multiple observational studies, including case series and case reports of patients who developed PMR following an acute MI, the core principles of repair in these patients were largely based on Carpentier's reconstructive valve techniques (11,13,14,18,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). The different surgical techniques used to repair the mitral valve in these studies included:…”

Section: Mitral Valve Replacementmentioning

confidence: 99%

“…The preference for mitral valve repair when compared to mitral valve replacement appeared to be higher in earlier studies reducing to 17% in the most recent case series (13), reflecting surgeons' preference for mitral valve replacement. Mitral valve repair failure rate ranged from 4% to 50% (11,13,14,18,(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37). This is likely to be due to a combination of edema, progression of tissue necrosis and lack of tensile strength in the ischemic tissues.…”

Section: Mitral Valve Replacementmentioning

confidence: 99%

Mitral valve repair in papillary muscle rupture

Hamid

Aksoy

Nia

2022

Ann Cardiothorac Surg

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Papillary muscle rupture (PMR) is a significant mechanical complication following myocardial infarction (MI), a condition associated with a high mortality. It results in severe mitral valve regurgitation (MR), often accompanied by cardiogenic shock and pulmonary edema, requiring both emergent medical treatment and surgical intervention. Surgical treatment includes either chordal sparing mitral valve replacement or mitral valve repair, which is associated with a high mortality. Mitral valve repair is believed to be superior to mitral valve replacement with respect to improving left ventricular function, albeit with risk of repair failure and resulting in increased cross clamp times. Concomitant coronary revascularization may improve both shortand long-term outcomes after surgery. With advances in medical innovations in the field of transcatheter devices, these devices may serve as a bridge to recovery or treatment in the setting of acute MR due to PMR.However, long-term data will be required to establish the non-inferiority of one treatment modality over the other. Management of these patients should be guided by a dedicated mitral heart team.

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

Cited by 34 publications

References 13 publications

Outcomes of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis

Outcomes of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis

Mitral valve surgery for ischemic papillary muscle rupture: outcomes from the Japan cardiovascular surgery database

Mitral valve repair in papillary muscle rupture

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