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Updated: Oct 15, 2025
A Hydrogel Construct and Fibrin-based Glue Approach to Deliver Therapeutics in a Murine Myocardial Infarction Model.
Published on: June 14, 2015
Surgical treatment for post-infarction papillary muscle rupture: a multicentre study
Giulio Massimi1, Daniele Ronco1,2, Michele De Bonis3
1Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands.
Objectives:
Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry.
Methods:
Patients underwent surgery for post-infarction PMR between 2001 through 2019 were retrieved from database of the CAUTION study. The primary end point was in-hospital mortality.
Results:
A total of 214 patients were included with a mean age of 66.9 (standard deviation: 10.5) years. The posteromedial papillary muscle was the most frequent rupture location (71.9%); the rupture was complete in 67.3% of patients. Mitral valve replacement was performed in 82.7% of cases. One hundred twenty-two patients (57%) had concomitant coronary artery bypass grafting. In-hospital mortality was 24.8%. Temporal trends revealed no apparent improvement in in-hospital mortality during the study period. Multivariable analysis showed that preoperative chronic kidney disfunction [odds ratio (OR): 2.62, 95% confidence interval (CI): 1.07-6.45, P = 0.036], cardiac arrest (OR: 3.99, 95% CI: 1.02-15.61, P = 0.046) and cardiopulmonary bypass duration (OR: 1.01, 95% CI: 1.00-1.02, P = 0.04) were independently associated with an increased risk of in-hospital death, whereas concomitant coronary artery bypass grafting was identified as an independent predictor of early survival (OR: 0.38, 95% CI: 0.16-0.92, P = 0.031).
Conclusions:
Surgical treatment for post-infarction PMR carries a high in-hospital mortality rate, which did not improve during the study period. Because concomitant coronary artery bypass grafting confers a survival benefit, this additional procedure should be performed, whenever possible, in an attempt to improve the outcome.
Clinical Trial Registration:
clinicaltrials.gov: NCT03848429.
Insights
Surgical repair of papillary muscle rupture after heart attack has a high mortality rate. Performing bypass surgery alongside it may improve survival chances.
Area of Science:
- Cardiology
- Cardiac Surgery
- Critical Care Medicine
Background:
- Papillary muscle rupture (PMR) is a rare but life-threatening complication of acute myocardial infarction.
- Surgical intervention is the primary treatment for post-infarction PMR.
Purpose of the Study:
- To analyze patient characteristics and early outcomes of surgical management for post-infarction PMR.
- To identify factors influencing in-hospital mortality in patients undergoing surgery for PMR.
Main Methods:
- Retrospective analysis of 214 patients who underwent surgery for post-infarction PMR from 2001-2019.
- Data sourced from the international multicentre CAUTION study registry.
- Primary endpoint was in-hospital mortality; multivariable analysis identified predictors of mortality and survival.
Main Results:
- The posteromedial papillary muscle was the most common rupture site (71.9%).
- Mitral valve replacement was performed in 82.7% of cases; 57% had concomitant coronary artery bypass grafting (CABG).
- In-hospital mortality was 24.8%, with no improvement over time. Preoperative kidney dysfunction, cardiac arrest, and longer bypass duration increased mortality risk, while concomitant CABG improved survival.
Conclusions:
- Surgical treatment for post-infarction PMR is associated with high in-hospital mortality.
- Concomitant CABG is an independent predictor of improved early survival and should be considered when feasible.
