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Repair Versus Replacement in Mitral Valve Papillary Muscle Rupture: A Multicenter Study

Giulio Massimi1,2, Matteo Matteucci1,3, Michele De Bonis4

  • 1Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, 6221, The Netherlands.

European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-Thoracic Surgery
|August 22, 2025
PubMed
Abstract

Insights

Surgery for papillary muscle rupture after myocardial infarction showed no significant difference in mortality between mitral valve repair and replacement. However, concomitant coronary artery bypass grafting improved in-hospital survival.

Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Cardiac Surgery Outcomes

Background:

  • Papillary muscle rupture (PMR) is a rare, life-threatening complication following acute myocardial infarction (AMI).
  • Surgical intervention is the standard treatment, but optimal strategies remain debated.
  • This study analyzes outcomes from the CAUTION study database.

Purpose of the Study:

  • To compare the effectiveness of mitral valve repair (MVr) versus mitral valve replacement (MVR) for post-AMI PMR.
  • To identify factors influencing in-hospital and long-term mortality.
  • To evaluate the impact of concomitant coronary artery bypass grafting (CABG).

Main Methods:

  • Retrospective analysis of 218 patients undergoing MVR or MVr for post-AMI PMR (2001-2019) from 20 international centers.
  • Comparison of in-hospital and long-term post-discharge mortality rates.
  • Multivariable logistic regression to identify independent predictors of mortality.

Main Results:

  • MVR was performed in 81.6% of cases, often for complete PMR, while MVr was more frequent in partial PMR.
  • In-hospital mortality was 25.8% for MVR and 20% for MVr (p=0.440).
  • Long-term survival showed no significant difference between MVR and MVr groups (p=0.474).
  • Concomitant CABG was associated with lower in-hospital mortality in the MVR group (21% vs 31.7%, p=0.035).
  • MVr with CABG demonstrated significantly higher long-term survival (p<0.001).

Conclusions:

  • MVR is preferred for complete PMR, and MVr for partial PMR.
  • No significant differences in in-hospital or long-term mortality were observed between MVR and MVr.
  • Concomitant CABG is associated with improved in-hospital survival, particularly in the MVr group.
Keywords:
mitral valvemitral valve repairmitral valve replacementmyocardial infarctionpapillary muscle rupture

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