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Long-term survival after mitral valve surgery for post-myocardial infarction papillary muscle rupture

Wobbe Bouma, Inez J Wijdh-den Hamer, Bart M Koene

    Journal of Cardiothoracic Surgery
    |January 28, 2015
    PubMed
    Abstract

    Insights

    Papillary muscle rupture after myocardial infarction is serious. Mitral valve surgery outcomes depend on patient risk scores and preserving the subvalvular apparatus.

    Area of Science:

    • Cardiology
    • Cardiac Surgery
    • Mechanical Complications of Myocardial Infarction

    Background:

    • Papillary muscle rupture (PMR) is a rare but severe mechanical complication following myocardial infarction (MI).
    • Immediate surgical intervention is critical for PMR, despite high associated risks.
    • This study investigates long-term survival predictors in patients undergoing mitral valve surgery for post-MI PMR.

    Purpose of the Study:

    • To identify predictors of overall long-term survival in patients who underwent mitral valve surgery for post-MI PMR.
    • To evaluate the impact of surgical techniques and patient-specific factors on survival outcomes.

    Main Methods:

    • A retrospective analysis of 50 consecutive patients undergoing mitral valve repair or replacement for post-MI PMR between 1990 and 2014.
    • Data collected included clinical, echocardiographic, catheterization, and surgical details.
    • Long-term survival was assessed using Kaplan-Meier curves and analyzed with univariate and multivariate Cox regression models.

    Main Results:

    • Kaplan-Meier survival rates at 20 years were 23.7±9.2%.
    • High logistic EuroSCORE (≥40%) and EuroSCORE II (≥25%) were significant predictors of reduced survival.
    • Preoperative inotropic support and mitral valve replacement without subvalvular apparatus preservation independently predicted lower long-term survival.

    Conclusions:

    • Elevated EuroSCOREs, preoperative inotropic support, and mitral valve replacement without subvalvular apparatus preservation are key predictors of poor long-term survival in post-MI PMR patients.
    • Preserving the subvalvular apparatus during surgery, when feasible, is recommended to improve patient outcomes.

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