Surgical treatment for post-infarction papillary muscle rupture: a multicentre study
Giulio Massimi, Daniele Ronco, Michele De Bonis, Mariusz Kowalewski, Francesco Formica, Claudio Russo, Sandro Sponga, Igor Vendramin, Giosuè Falcetta, Theodor Fischlein, Giovanni Troise, Cinzia Trumello, Guglielmo Mario Actis Dato, Massimiliano Carrozzini, Shabir Hussain Shah, Valeria Lo Coco, Emmanuel Villa, Roberto Scrofani, Federica Torchio, Carlo Antona, Jurij Matija Kališnik, Stefano D’Alessandro, Matteo Pettinari, Peyman Sardari Nia, Vittoria Lodo, Andrea Colli, Arjang Ruhparwar, Matthias Thielmann, Bart Meyns, Fareed Khouqeer, Carlo Fino, Caterina Simon, Adam Kowalówka, Marek Deja, Cesare Beghi, Matteo Matteucci, Roberto Lorusso
Abstract
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.