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 inEuropean journal of cardio-thoracic surgery Vol. 67; no. 9
Main Authors Massimi, Giulio, Matteucci, Matteo, De Bonis, Michele, Kowalewski, Mariusz, Formica, Francesco, Russo, Claudio Francesco, Sponga, Sandro, Vendramin, Igor, Colli, Andrea, Falcetta, Giosuè, Trumello, Cinzia, Carrozzini, Massimiliano, Fischlein, Theodor, Troise, Giovanni, Dato, Guglielmo Actis, D’Alessandro, Stefano, Nia, Peyman Sardari, Lodo, Vittoria, Villa, Emmanuel, Shah, Shabir Hussain, Scrofani, Roberto, Binaco, Irene, Kalisnik, Jurij Matija, Dell’Uomo, Marco, Pettinari, Matteo, Thielmann, Matthias, Meyns, Bart, Khouqeer, Fareed A, Fino, Carlo, Simon, Caterina, Musazzi, Andrea, Kowalowka, Adam, Deja, Marek A, Pisani, Angelo, Batko, Jakub, Borghetti, Valentino, Ronco, Daniele, Di Mauro, Michele, Lorusso, Roberto
Format Journal Article
LanguageEnglish
Published Germany Oxford University Press 02.09.2025
Subjects
Online AccessGet full text
ISSN1873-734X
1873-734X
DOI10.1093/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
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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The Author(s) 2025. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
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Issue 9
Keywords mitral valve
papillary muscle rupture
mitral valve replacement
mitral valve repair
myocardial infarction
Language English
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The Author(s) 2025. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.
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PublicationDate 2025-Sep-02
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  text: 2025-Sep-02
  day: 02
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PublicationTitle European journal of cardio-thoracic surgery
PublicationTitleAlternate Eur J Cardiothorac Surg
PublicationYear 2025
Publisher Oxford University Press
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Snippet Abstract Objectives 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
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