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Mitral valve surgery for acute papillary muscle rupture following myocardial infarction.
- Source :
-
The Journal of heart valve disease [J Heart Valve Dis] 2002 Jan; Vol. 11 (1), pp. 27-31. - Publication Year :
- 2002
-
Abstract
- Background and Aim of the Study: Acute papillary muscle rupture (PMR) is a rare but fatal complication of myocardial infarction (MI). Surgery represents the best treatment option, but carries a high risk. Our experience of emergency mitral valve surgery in patients with acute PMR following MI during the past 22 years is reviewed.<br />Methods: Between 1978 and 2000, 33 patients (20 males, 13 females; mean age 64 years; range: 46-80) underwent emergency surgery for acute post-infarct PMR in our institution. The site of MI was anterior in three patients and inferior in 30. Preoperatively, 17 patients had an intra-aortic balloon pump (IABP) inserted, 26 were on inotropic support, and 17 were ventilated. Twenty patients (61%) underwent concomitant coronary bypass grafting (CABG). The valve was replaced in 31 patients and repaired in two. Mean (+/- SD) duration of follow up was 63+/-54 months (range: 0-183 months).<br />Results: Early mortality (in-hospital) was 21% (n = 7). Factors associated with significant risk of early mortality included raised preoperative serum creatinine (p = 0.02), need for preoperative inotropic support (p = 0.03) and preoperative ventilation (p = 0.03). Raised preoperative serum creatinine remained significant on multiple logistic regression (p = 0.04). Postoperatively, 21 patients required an IABP. Mean duration of intensive care unit stay was 4+/-2.5 days (range: 0-10 days). Survival, including in-hospital mortality, at one, five and 10 years was 75+/-7.4, 65+/-8.6 and 32+/-9.7%, respectively. Four patients required valve-related reoperation (three for a paraprosthetic leak, one for failed repair).<br />Conclusion: Patients with acute post-infarct PMR present in a severely compromised state. Early mortality is high, but the intermediate outcome is encouraging for operative survivors.
- Subjects :
- Aged
Aged, 80 and over
Cardiomyopathies surgery
Coronary Artery Bypass
Emergencies
Female
Heart Rupture, Post-Infarction mortality
Heart Rupture, Post-Infarction surgery
Humans
Length of Stay
Male
Middle Aged
Mitral Valve Insufficiency etiology
Reoperation
Cardiomyopathies complications
Heart Rupture, Post-Infarction complications
Mitral Valve Insufficiency surgery
Papillary Muscles
Subjects
Details
- Language :
- English
- ISSN :
- 0966-8519
- Volume :
- 11
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Journal of heart valve disease
- Publication Type :
- Academic Journal
- Accession number :
- 11843503