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Reparación versus reemplazo en la ruptura del músculo papilar de la válvula mitral: un estudio multicéntrico

Giulio Massimi^1,2, Matteo Matteucci^1,3, Michele De Bonis⁴

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

European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

|August 22, 2025

Resumen

La cirugía para la ruptura del músculo papilar después del infarto de miocardio no mostró ninguna diferencia significativa en la mortalidad entre la reparación y el reemplazo de la válvula mitral. Sin embargo, el bypass coronario concomitante mejoró la supervivencia en el hospital.

Área de la Ciencia:

Cirugía cardiovascular
Cardiología intervencionista
Resultados de la cirugía cardíaca

Sus antecedentes:

La ruptura muscular papilar (RMP) es una complicación rara y potencialmente mortal después de un infarto agudo de miocardio (AMI).
La intervención quirúrgica es el tratamiento estándar, pero las estrategias óptimas siguen siendo objeto de debate.
Este estudio analiza los resultados de la base de datos del estudio CAUTION.

Objetivo del estudio:

Para comparar la eficacia de la reparación de la válvula mitral (MVr) frente al reemplazo de la válvula mitral (MVR) para la PMR posterior a la AMI.
Identificar los factores que influyen en la mortalidad hospitalaria y a largo plazo.
Para evaluar el impacto del bypass coronario concomitante (CABG).

Principales métodos:

Análisis retrospectivo de 218 pacientes sometidos a MVR o MVR para PMR después de AMI (2001-2019) de 20 centros internacionales.
Comparación de las tasas de mortalidad hospitalaria y a largo plazo después del alta.
Regresión logística multivariable para identificar los predictores independientes de la mortalidad.

Principales resultados:

MVR se realizó en el 81,6% de los casos, a menudo para PMR completo, mientras que MVR fue más frecuente en PMR parcial.
La mortalidad hospitalaria fue del 25,8% para MVR y del 20% para MVr (p=0,440).
La supervivencia a largo plazo no mostró diferencias significativas entre los grupos MVR y MVr (p=0,474).
La administración concomitante de CABG se asoció con una menor mortalidad hospitalaria en el grupo MVR (21% frente a 31,7%, p=0,035).
MVr con CABG demostró una supervivencia a largo plazo significativamente mayor (p< 0,001).

Conclusiones:

Se prefiere MVR para la PMR completa y MVr para la PMR parcial.
No se observaron diferencias significativas en la mortalidad hospitalaria o a largo plazo entre MVR y MVr.
La administración concomitante de CABG está asociada con una mejor supervivencia hospitalaria, particularmente en el grupo MVr.

Palabras clave:

Válvula mitral Reparación de la válvula mitral Cambio de la válvula mitral Infarto de miocardio ruptura del músculo papilar

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