Surgical treatment of post-infarction papillary muscle rupture: systematic review and meta-analysis

G. Massimi, M. Matteucci*, M. Kowalewski, D. Ronco, F. Jiritano, C. Beghi, P. Severgnini, R. Lorusso

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Background: Papillary muscle rupture (PMR) is a rare but potentially fatal complication following acute myocardial infarction (AMI). Surgical treatment is considered the standard of care. This systematic review and meta-analysis aims to evaluate the early outcomes after surgical correction of post-AMI PMR. Methods: Electronic databases were searched from January 1990 to December 2020. Studies reporting patients undergoing mitral valve surgery for post-AMI PMR were analysed. The primary outcome assessed was operative mortality. Differences were expressed as risk ratio (RR) with 95% confidence interval (CI) to assess the relationships between predefined surgical variables and clinical prognosis. Results: A total of 1,851 adult patients, from 12 observational studies, were identified. Operative mortality was 21%. Meta-analysis revealed reduced operative risk in patients undergoing mitral valve repair (MVr) as compared to replacement (MVR) (RR, 0.33; 95% CI: 0.14 to 0.79; P=0.01), and an increased risk of operative mortality in patients with complete PMR (RR, 2.54; 95% CI: 1.12 to 5.74; P=0.03). No significant differences in terms of operative mortality were observed between patients with or without pre/peri-operative intra-aortic balloon pump (IABP) support and between subjects who underwent mitral valve surgery with or without concomitant coronary artery bypass grafting (CABG). Conclusions: Mitral valve surgery for post-AMI PMR carries a high operative mortality. Patients with complete PMR and subjects undergoing MVR have increased risks of operative mortality.

Original languageEnglish
Pages (from-to)252-260
Number of pages12
JournalAnnals of Cardiothoracic Surgery
Volume11
Issue number3
Early online date11 Jan 2022
DOIs
Publication statusPublished - May 2022

Keywords

  • Papillary muscle rupture (PMR)
  • mitral valve surgery
  • mitral regurgitation
  • MITRAL-VALVE SURGERY
  • EXTRACORPOREAL MEMBRANE-OXYGENATION
  • ACUTE MYOCARDIAL-INFARCTION
  • MECHANICAL COMPLICATIONS
  • CARDIOGENIC-SHOCK
  • REGURGITATION
  • MANAGEMENT

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