TY - JOUR
T1 - Clinical outcome after mitral valve surgery due to ischemic papillary muscle rupture
AU - Schroeter, Thomas
AU - Lehmann, Sven
AU - Misfeld, Martin
AU - Borger, Michael
AU - Subramanian, Sreekumar
AU - Mohr, Friedrich W.
AU - Bakthiary, Farhad
PY - 2013/3
Y1 - 2013/3
N2 - Background: Severe mitral regurgitation secondary to papillary muscle rupture is an infrequent but catastrophic complication after myocardial infarction. Without surgical treatment, mortality can reach 80%, but surgical treatment also carries substantial perioperative morbidity and mortality. Methods: We retrospectively analyzed 28 patients who underwent mitral valve surgery for ischemic papillary muscle rupture. Results: The 30-day mortality rate was 39.3% (11 of 28). There were no significant differences in the baseline characteristics, and concomitant coronary artery bypass (CABG) was performed in 66.7% of the survivor group and in 61.5% of the nonsurvivor group (p = 0.245). Mortality predictors included low cardiac output (p = 0.05), renal failure (p = 0.005), and implementation of extracorporeal membrane oxygenation therapy (p = 0.005). The time between myocardial infarction and surgery showed no significant effects on survival. Conclusions: Papillary muscle rupture with severe mitral regurgitation carries a high operative mortality. Additional CABG does not influence the acute postoperative course. Postoperative development of low cardiac output with a need for extracorporeal membrane oxygenation therapy and renal failure with hemodialysis substantially reduces survival.
AB - Background: Severe mitral regurgitation secondary to papillary muscle rupture is an infrequent but catastrophic complication after myocardial infarction. Without surgical treatment, mortality can reach 80%, but surgical treatment also carries substantial perioperative morbidity and mortality. Methods: We retrospectively analyzed 28 patients who underwent mitral valve surgery for ischemic papillary muscle rupture. Results: The 30-day mortality rate was 39.3% (11 of 28). There were no significant differences in the baseline characteristics, and concomitant coronary artery bypass (CABG) was performed in 66.7% of the survivor group and in 61.5% of the nonsurvivor group (p = 0.245). Mortality predictors included low cardiac output (p = 0.05), renal failure (p = 0.005), and implementation of extracorporeal membrane oxygenation therapy (p = 0.005). The time between myocardial infarction and surgery showed no significant effects on survival. Conclusions: Papillary muscle rupture with severe mitral regurgitation carries a high operative mortality. Additional CABG does not influence the acute postoperative course. Postoperative development of low cardiac output with a need for extracorporeal membrane oxygenation therapy and renal failure with hemodialysis substantially reduces survival.
UR - http://www.scopus.com/inward/record.url?scp=84874593861&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84874593861&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2012.10.050
DO - 10.1016/j.athoracsur.2012.10.050
M3 - Article
C2 - 23219255
AN - SCOPUS:84874593861
SN - 0003-4975
VL - 95
SP - 820
EP - 824
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 3
ER -