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Surgical treatment of post-infarction papillary muscle rupture: systematic review and meta-analysis

Giulio Massimi1, Matteo Matteucci1,2, Mariusz Kowalewski1,3,4

  • 1Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.

Annals of Cardiothoracic Surgery
|June 23, 2022
PubMed
Abstract

Insights

Papillary muscle rupture after heart attack is deadly. Mitral valve repair is safer than replacement, while complete rupture increases mortality risk. Early outcomes for this rare complication are high-risk.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Research

Background:

  • Papillary muscle rupture (PMR) is a rare, life-threatening complication of acute myocardial infarction (AMI).
  • Surgical intervention is the established treatment for post-AMI PMR.
  • This study systematically reviews early outcomes of surgical correction for PMR.

Purpose of the Study:

  • To evaluate early outcomes following surgical correction of post-acute myocardial infarction papillary muscle rupture.
  • To compare the effectiveness of different surgical approaches for post-AMI PMR.

Main Methods:

  • A systematic review and meta-analysis of observational studies published between January 1990 and December 2020.
  • Analysis of data from 1,851 adult patients undergoing mitral valve surgery for post-AMI PMR.
  • Assessment of operative mortality as the primary outcome, using risk ratios (RR) and 95% confidence intervals (CI).

Main Results:

  • Overall operative mortality for post-AMI PMR surgery was 21%.
  • Mitral valve repair (MVr) was associated with significantly lower operative risk compared to mitral valve replacement (MVR) (RR, 0.33; 95% CI: 0.14 to 0.79).
  • Complete PMR increased operative mortality risk (RR, 2.54; 95% CI: 1.12 to 5.74), while intra-aortic balloon pump (IABP) support and coronary artery bypass grafting (CABG) did not significantly impact early outcomes.

Conclusions:

  • Surgical management of post-AMI PMR is associated with high operative mortality.
  • Mitral valve replacement and complete PMR are linked to increased operative mortality.
  • Preoperative IABP support and concomitant CABG do not appear to affect early postoperative outcomes in this patient group.
Keywords:
Papillary muscle rupture (PMR)mitral regurgitationmitral valve surgery

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