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Mitral valve surgery for ischemic papillary muscle rupture: outcomes from the Japan cardiovascular surgery database
Tomoyuki Fujita1, Hiroyuki Yamamoto2,3, Junjiro Kobayashi4
1Department of Cardiothoracic Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibeshimmachi, Suita, Osaka, 564-8565, Japan. tfujita@ncvc.go.jp.
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.
Insights
Papillary muscle rupture (PMR) after acute myocardial infarction (AMI) is rare but severe, with a 26% hospital mortality rate. Risk factors like hemodialysis and preoperative ECMO significantly increase mortality risk in these patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Clinical Outcomes Research
Background:
- Ischemic papillary muscle rupture (PMR) is a rare but devastating complication of acute myocardial infarction (AMI).
- Early outcomes of PMR following AMI require further investigation using comprehensive registry data.
Purpose of the Study:
- To evaluate the early outcomes of patients who experienced PMR following AMI.
- To identify risk factors associated with operative mortality and severe complications after mitral valve surgery in PMR patients.
Main Methods:
- Retrospective analysis of 196 patients diagnosed with PMR post-AMI in Japan (2014-2017).
- Utilized data from the Japan Cardiovascular Surgery Database, a nationwide registry.
- Analyzed risk factors for mortality and complications following mitral valve surgery.
Main Results:
- The 30-day and hospital mortality rates were 20% and 26%, respectively.
- Factors associated with mortality included chronic hemodialysis, abrupt rupture, resuscitation before surgery, and preoperative venoarterial extracorporeal membrane oxygenation (ECMO).
- Mitral valve replacement (90%) was the primary surgical approach; no significant short-term outcome difference was observed between mitral valve replacement and repair.
Conclusions:
- PMR is a rare but severe condition associated with high mortality following AMI.
- The severity of PMR correlates with an increased risk of poor outcomes.
- Identifying and managing risk factors is crucial for improving patient survival.