Surgical treatment for post-infarction papillary muscle rupture: a multicentre study

Giulio Massimi; Daniele Ronco; Michele De Bonis; Mariusz Kowalewski; Francesco Formica; Claudio Francesco Russo; Sandro Sponga; Igor Vendramin; Giosuè Falcetta; Theodor Fischlein; Giovanni Troise; Cinzia Trumello; Guglielmo Actis Dato; Massimiliano Carrozzini; Shabir Hussain Shah; Valeria Lo Coco; Emmanuel Villa; Roberto Scrofani; Federica Torchio; Carlo Antona; Jurij Matija Kalisnik; Stefano D'Alessandro; Matteo Pettinari; Peyman Sardari Nia; Vittoria Lodo; Andrea Colli; Arjang Ruhparwar; Matthias Thielmann; Bart Meyns; Fareed A Khouqeer; Carlo Fino; Caterina Simon; Adam Kowalowka; Marek A Deja; Cesare Beghi; Matteo Matteucci; Roberto Lorusso

doi:10.1093/ejcts/ezab469

Surgical treatment for post-infarction papillary muscle rupture: a multicentre study

Giulio Massimi^*, Daniele Ronco, Michele De Bonis, Mariusz Kowalewski, Francesco Formica, Claudio Francesco Russo, Sandro Sponga, Igor Vendramin, Giosuè Falcetta, Theodor Fischlein, Giovanni Troise, Cinzia Trumello, Guglielmo Actis Dato, Massimiliano Carrozzini, Shabir Hussain Shah, Valeria Lo Coco, Emmanuel Villa, Roberto Scrofani, Federica Torchio, Carlo AntonaJurij Matija Kalisnik, Stefano D'Alessandro, Matteo Pettinari, Peyman Sardari Nia, Vittoria Lodo, Andrea Colli, Arjang Ruhparwar, Matthias Thielmann, Bart Meyns, Fareed A Khouqeer, Carlo Fino, Caterina Simon, Adam Kowalowka, Marek A Deja, Cesare Beghi, Matteo Matteucci, Roberto Lorusso

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Pages (from-to)	469-476
Number of pages	8
Journal	European Journal of Cardio-Thoracic Surgery
Volume	61
Issue number	2
DOIs	https://doi.org/10.1093/ejcts/ezab469
Publication status	Published - 24 Jan 2022

Keywords

ACUTE MYOCARDIAL-INFARCTION
Acute mitral regurgitation
MITRAL-VALVE SURGERY
Mitral valve surgery
Papillary muscle rupture
REGURGITATION
REPAIR
REPLACEMENT
SURVIVAL

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10.1093/ejcts/ezab469

Cite this

Massimi, G., Ronco, D., De Bonis, M., Kowalewski, M., Formica, F., Russo, C. F., Sponga, S., Vendramin, I., Falcetta, G., Fischlein, T., Troise, G., Trumello, C., Actis Dato, G., Carrozzini, M., Shah, S. H., Coco, V. L., Villa, E., Scrofani, R., Torchio, F., ... Lorusso, R. (2022). Surgical treatment for post-infarction papillary muscle rupture: a multicentre study. European Journal of Cardio-Thoracic Surgery, 61(2), 469-476. https://doi.org/10.1093/ejcts/ezab469

@article{7a9e5f51204841488160d3d0f7e78a6c,

title = "Surgical treatment for post-infarction papillary muscle rupture: a multicentre study",

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.",

keywords = "ACUTE MYOCARDIAL-INFARCTION, Acute mitral regurgitation, MITRAL-VALVE SURGERY, Mitral valve surgery, Papillary muscle rupture, REGURGITATION, REPAIR, REPLACEMENT, SURVIVAL",

author = "Giulio Massimi and Daniele Ronco and {De Bonis}, Michele and Mariusz Kowalewski and Francesco Formica and Russo, {Claudio Francesco} and Sandro Sponga and Igor Vendramin and Giosu{\`e} Falcetta and Theodor Fischlein and Giovanni Troise and Cinzia Trumello and {Actis Dato}, Guglielmo and Massimiliano Carrozzini and Shah, {Shabir Hussain} and Coco, {Valeria Lo} and Emmanuel Villa and Roberto Scrofani and Federica Torchio and Carlo Antona and Kalisnik, {Jurij Matija} and Stefano D'Alessandro and Matteo Pettinari and {Sardari Nia}, Peyman and Vittoria Lodo and Andrea Colli and Arjang Ruhparwar and Matthias Thielmann and Bart Meyns and Khouqeer, {Fareed A} and Carlo Fino and Caterina Simon and Adam Kowalowka and Deja, {Marek A} and Cesare Beghi and Matteo Matteucci and Roberto Lorusso",

year = "2022",

month = jan,

day = "24",

doi = "10.1093/ejcts/ezab469",

language = "English",

volume = "61",

pages = "469--476",

journal = "European Journal of Cardio-Thoracic Surgery",

issn = "1010-7940",

publisher = "Oxford University Press",

number = "2",

}

Massimi, G , Ronco, D, De Bonis, M, Kowalewski, M, Formica, F, Russo, CF, Sponga, S, Vendramin, I, Falcetta, G, Fischlein, T, Troise, G, Trumello, C, Actis Dato, G, Carrozzini, M, Shah, SH, Coco, VL, Villa, E, Scrofani, R, Torchio, F, Antona, C, Kalisnik, JM, D'Alessandro, S, Pettinari, M, Sardari Nia, P, Lodo, V, Colli, A, Ruhparwar, A, Thielmann, M, Meyns, B, Khouqeer, FA, Fino, C, Simon, C, Kowalowka, A, Deja, MA, Beghi, C, Matteucci, M & Lorusso, R 2022, 'Surgical treatment for post-infarction papillary muscle rupture: a multicentre study', European Journal of Cardio-Thoracic Surgery, vol. 61, no. 2, pp. 469-476. https://doi.org/10.1093/ejcts/ezab469

TY - JOUR

T1 - Surgical treatment for post-infarction papillary muscle rupture

T2 - a multicentre study

AU - Massimi, Giulio

AU - Ronco, Daniele

AU - De Bonis, Michele

AU - Kowalewski, Mariusz

AU - Formica, Francesco

AU - Russo, Claudio Francesco

AU - Sponga, Sandro

AU - Vendramin, Igor

AU - Falcetta, Giosuè

AU - Fischlein, Theodor

AU - Troise, Giovanni

AU - Trumello, Cinzia

AU - Actis Dato, Guglielmo

AU - Carrozzini, Massimiliano

AU - Shah, Shabir Hussain

AU - Coco, Valeria Lo

AU - Villa, Emmanuel

AU - Scrofani, Roberto

AU - Torchio, Federica

AU - Antona, Carlo

AU - Kalisnik, Jurij Matija

AU - D'Alessandro, Stefano

AU - Pettinari, Matteo

AU - Sardari Nia, Peyman

AU - Lodo, Vittoria

AU - Colli, Andrea

AU - Ruhparwar, Arjang

AU - Thielmann, Matthias

AU - Meyns, Bart

AU - Khouqeer, Fareed A

AU - Fino, Carlo

AU - Simon, Caterina

AU - Kowalowka, Adam

AU - Deja, Marek A

AU - Beghi, Cesare

AU - Matteucci, Matteo

AU - Lorusso, Roberto

PY - 2022/1/24

Y1 - 2022/1/24

N2 - : 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.

AB - : 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.

KW - ACUTE MYOCARDIAL-INFARCTION

KW - Acute mitral regurgitation

KW - MITRAL-VALVE SURGERY

KW - Mitral valve surgery

KW - Papillary muscle rupture

KW - REGURGITATION

KW - REPAIR

KW - REPLACEMENT

KW - SURVIVAL

U2 - 10.1093/ejcts/ezab469

DO - 10.1093/ejcts/ezab469

M3 - Article

C2 - 34718501

SN - 1010-7940

VL - 61

SP - 469

EP - 476

JO - European Journal of Cardio-Thoracic Surgery

JF - European Journal of Cardio-Thoracic Surgery

IS - 2

ER -