Repair Versus Replacement in Mitral Valve Papillary Muscle Rupture: A Multicenter Study
Abstract Objectives Papillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Although surgery is considered the gold-standard treatment for post-AMI PMR, the optimal surgical strategy remains unclear. Methods Data from post-AMI P...
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Published in | European journal of cardio-thoracic surgery Vol. 67; no. 9 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Germany
Oxford University Press
02.09.2025
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Subjects | |
Online Access | Get full text |
ISSN | 1873-734X 1873-734X |
DOI | 10.1093/ejcts/ezaf284 |
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Abstract | Abstract
Objectives
Papillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Although surgery is considered the gold-standard treatment for post-AMI PMR, the optimal surgical strategy remains unclear.
Methods
Data from post-AMI PMR patients submitted to mitral valve replacement (MVR) or mitral valve repair (MVr) surgery in the period between 2001 and 2019, from 20 international centres, were collected in the CAUTION study database. In-hospital and long-term post-discharge mortality were the endpoints. A multivariable logistic regression model was used to determine mortality independent factors.
Results
The patient cohort available included 218 patients. MVR was the most frequent type of surgery (81.6%). Complete PMR was more common in the MVR group (71.9%, P = .008), while partial PMR was more frequent in MVr patients (75%, P = .008). In-hospital mortality rate was 25.8% in the MVR subgroup and 20% in MVr subjects (P = .440). In MVR subgroup, concomitant coronary artery bypass grafting (CABG) was associated with lower in-hospital mortality (n = 20/96, 21%) than no concomitant CABG (31.7%, P = .035). Survival at 1, 3, 5, and 10 years was 59.3%, 55.9%, 53.1%, 46.9% in the MVR group and 59.9%, 56.8%, 54.1%, and 43.2% in MVr patients, respectively, with no statistical differences (P = .474). Patients underwent MVr surgery, and 1-, 3-, 5-, and 10-year survival was 79.8%, 75.4%, 68.5%, and 37.5%, respectively, when CABG revascularization was performed, while no CABG survival was 16.7%, 16.7%, 8.3%, and 8.3% (P < .001).
Conclusions
MVR is the most commonly performed in complete post-AMI PMR and MVr in partial PMR. No differences were observed regarding in-hospital and long-term mortality in the 2 surgical groups, and no independent factors were associated with overall mortality. Concomitant CABG was associated with higher in-hospital survival.
Clinical Registration Number
Clinicaltrials.gov, NCT03848429.
Papillary muscle rupture (PMR) is a rare but life-threatening complication of acute myocardial infarction (AMI).
Graphical Abstract |
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AbstractList | Abstract
Objectives
Papillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Although surgery is considered the gold-standard treatment for post-AMI PMR, the optimal surgical strategy remains unclear.
Methods
Data from post-AMI PMR patients submitted to mitral valve replacement (MVR) or mitral valve repair (MVr) surgery in the period between 2001 and 2019, from 20 international centres, were collected in the CAUTION study database. In-hospital and long-term post-discharge mortality were the endpoints. A multivariable logistic regression model was used to determine mortality independent factors.
Results
The patient cohort available included 218 patients. MVR was the most frequent type of surgery (81.6%). Complete PMR was more common in the MVR group (71.9%, P = .008), while partial PMR was more frequent in MVr patients (75%, P = .008). In-hospital mortality rate was 25.8% in the MVR subgroup and 20% in MVr subjects (P = .440). In MVR subgroup, concomitant coronary artery bypass grafting (CABG) was associated with lower in-hospital mortality (n = 20/96, 21%) than no concomitant CABG (31.7%, P = .035). Survival at 1, 3, 5, and 10 years was 59.3%, 55.9%, 53.1%, 46.9% in the MVR group and 59.9%, 56.8%, 54.1%, and 43.2% in MVr patients, respectively, with no statistical differences (P = .474). Patients underwent MVr surgery, and 1-, 3-, 5-, and 10-year survival was 79.8%, 75.4%, 68.5%, and 37.5%, respectively, when CABG revascularization was performed, while no CABG survival was 16.7%, 16.7%, 8.3%, and 8.3% (P < .001).
Conclusions
MVR is the most commonly performed in complete post-AMI PMR and MVr in partial PMR. No differences were observed regarding in-hospital and long-term mortality in the 2 surgical groups, and no independent factors were associated with overall mortality. Concomitant CABG was associated with higher in-hospital survival.
Clinical Registration Number
Clinicaltrials.gov, NCT03848429.
Papillary muscle rupture (PMR) is a rare but life-threatening complication of acute myocardial infarction (AMI).
Graphical Abstract Papillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Despite surgery is considered the gold-standard treatment for post-AMI PMR, the optimal surgical strategy remains unclear.OBJECTIVESPapillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Despite surgery is considered the gold-standard treatment for post-AMI PMR, the optimal surgical strategy remains unclear.Data from post-AMI PMR patients submitted to MVR or MVr surgery in the period between 2001 and 2019, from 20 international centers, were collected in the CAUTION study database. In-hospital, and long-term post-discharge mortality were the end-points. Multivariable logistic regression model was used to determine mortality independent factors.METHODSData from post-AMI PMR patients submitted to MVR or MVr surgery in the period between 2001 and 2019, from 20 international centers, were collected in the CAUTION study database. In-hospital, and long-term post-discharge mortality were the end-points. Multivariable logistic regression model was used to determine mortality independent factors.The patient cohort available included 218 patients. MVR was the most frequent type of surgery (81.6%). Complete PMR was more common in MVR group (71.9%, p = 0.008), while partial PMR was more frequent in MVr patients (75%, p = 0.008). In-hospital mortality rate was 25.8% in MVR subgroup and 20% in MVr subjects (p = 0.440). In MVR subgroup, concomitant CABG was associated with lower in-hospital mortality (n = 20/96, 21%) than no concomitant CABG (31.7%, p = 0.035). Survival at 1,3,5 and 10 years was 59.3%, 55.9%,53.1%,46.9% in MVR group and 59.9%,56.8%,54.1% and 43.2% in MVr patients, respectively, with no statistical differences (p = 0.474). Patients underwent MVr surgery 1,3,5 and 10 years survival was 79.8%, 75.4%, 68.5% and 37.5% when CABG revascularization is performed, while no CABG survival was 16.7%, 16.7%, 8.3% and 8.3% (p < 0.001).RESULTSThe patient cohort available included 218 patients. MVR was the most frequent type of surgery (81.6%). Complete PMR was more common in MVR group (71.9%, p = 0.008), while partial PMR was more frequent in MVr patients (75%, p = 0.008). In-hospital mortality rate was 25.8% in MVR subgroup and 20% in MVr subjects (p = 0.440). In MVR subgroup, concomitant CABG was associated with lower in-hospital mortality (n = 20/96, 21%) than no concomitant CABG (31.7%, p = 0.035). Survival at 1,3,5 and 10 years was 59.3%, 55.9%,53.1%,46.9% in MVR group and 59.9%,56.8%,54.1% and 43.2% in MVr patients, respectively, with no statistical differences (p = 0.474). Patients underwent MVr surgery 1,3,5 and 10 years survival was 79.8%, 75.4%, 68.5% and 37.5% when CABG revascularization is performed, while no CABG survival was 16.7%, 16.7%, 8.3% and 8.3% (p < 0.001).MVR is the mostly performed in complete post-AMI PMR and MVr in partial PMR. No differences were observed regarding in-hospital and long-term mortality in the two surgical groups, and no independent factors were associated with overall mortality. Concomitant CABG was associated to higher in-hospital survival.CONCLUSIONSMVR is the mostly performed in complete post-AMI PMR and MVr in partial PMR. No differences were observed regarding in-hospital and long-term mortality in the two surgical groups, and no independent factors were associated with overall mortality. Concomitant CABG was associated to higher in-hospital survival.Clinicaltrials.gov, NCT03848429.CLINICAL REGISTRATION NUMBERClinicaltrials.gov, NCT03848429. Papillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Although surgery is considered the gold-standard treatment for post-AMI PMR, the optimal surgical strategy remains unclear. Data from post-AMI PMR patients submitted to mitral valve replacement (MVR) or mitral valve repair (MVr) surgery in the period between 2001 and 2019, from 20 international centres, were collected in the CAUTION study database. In-hospital and long-term post-discharge mortality were the endpoints. A multivariable logistic regression model was used to determine mortality independent factors. The patient cohort available included 218 patients. MVR was the most frequent type of surgery (81.6%). Complete PMR was more common in the MVR group (71.9%, P = .008), while partial PMR was more frequent in MVr patients (75%, P = .008). In-hospital mortality rate was 25.8% in the MVR subgroup and 20% in MVr subjects (P = .440). In MVR subgroup, concomitant coronary artery bypass grafting (CABG) was associated with lower in-hospital mortality (n = 20/96, 21%) than no concomitant CABG (31.7%, P = .035). Survival at 1, 3, 5, and 10 years was 59.3%, 55.9%, 53.1%, 46.9% in the MVR group and 59.9%, 56.8%, 54.1%, and 43.2% in MVr patients, respectively, with no statistical differences (P = .474). Patients underwent MVr surgery, and 1-, 3-, 5-, and 10-year survival was 79.8%, 75.4%, 68.5%, and 37.5%, respectively, when CABG revascularization was performed, while no CABG survival was 16.7%, 16.7%, 8.3%, and 8.3% (P < .001). MVR is the most commonly performed in complete post-AMI PMR and MVr in partial PMR. No differences were observed regarding in-hospital and long-term mortality in the 2 surgical groups, and no independent factors were associated with overall mortality. Concomitant CABG was associated with higher in-hospital survival. Clinicaltrials.gov, NCT03848429. |
Author | Pisani, Angelo Trumello, Cinzia Borghetti, Valentino Binaco, Irene Russo, Claudio Francesco Musazzi, Andrea Vendramin, Igor Pettinari, Matteo Lorusso, Roberto Lodo, Vittoria Villa, Emmanuel Di Mauro, Michele Massimi, Giulio D’Alessandro, Stefano Dell’Uomo, Marco Falcetta, Giosuè Meyns, Bart Ronco, Daniele Simon, Caterina Dato, Guglielmo Actis Shah, Shabir Hussain Formica, Francesco Kowalowka, Adam Sponga, Sandro Fino, Carlo Carrozzini, Massimiliano Thielmann, Matthias Troise, Giovanni Khouqeer, Fareed A Kalisnik, Jurij Matija De Bonis, Michele Fischlein, Theodor Batko, Jakub Colli, Andrea Matteucci, Matteo Kowalewski, Mariusz Deja, Marek A Scrofani, Roberto Nia, Peyman Sardari |
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Keywords | mitral valve papillary muscle rupture mitral valve replacement mitral valve repair myocardial infarction |
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Papillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Although... Papillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Although surgery is considered... Papillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Despite surgery is considered... |
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SubjectTerms | Aged Female Heart Rupture, Post-Infarction - mortality Heart Rupture, Post-Infarction - surgery Heart Valve Prosthesis Implantation - methods Heart Valve Prosthesis Implantation - mortality Hospital Mortality Humans Male Middle Aged Mitral Valve - surgery Mitral Valve Insufficiency - surgery Myocardial Infarction - complications Papillary Muscles - injuries Papillary Muscles - surgery Retrospective Studies |
Title | Repair Versus Replacement in Mitral Valve Papillary Muscle Rupture: A Multicenter Study |
URI | https://www.ncbi.nlm.nih.gov/pubmed/40845148 https://www.proquest.com/docview/3246315159 |
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