Mitral valve surgery for ischemic papillary muscle rupture: outcomes from the Japan cardiovascular surgery database

Tomoyuki Fujita, Hiroyuki Yamamoto, Junjiro Kobayashi, Satsuki Fukushima, Hiroaki Miyata, Kizuku Yamashita, Noboru Motomura

Research output: Contribution to journalArticle

Abstract

Background: Ischemic papillary muscle rupture (PMR) is a catastrophic complication following acute myocardial infarction (AMI). We evaluated early outcomes of PMR by using data from the Japan Cardiovascular Surgery Database, a nationwide Japanese registry. Methods: We retrospectively analyzed data from 196 patients diagnosed with PMR following AMI in Japan between January 2014 and December 2017. Risk factors for operative mortality and severe complications following mitral valve surgery were analyzed. Results: The 30-day and hospital mortality rates were 20% and 26%, respectively. Chronic hemodialysis, abrupt rupture after AMI, resuscitation before surgery, and preoperative venoarterial extracorporeal membrane oxygenation were associated with mortality. Mitral valve replacement was chosen mainly (90%) for surgical correction of mitral regurgitation in these patients. There was no significant difference in short-term outcomes between mitral valve replacement versus mitral valve repair, despite non-matched characteristics in background between the treatment groups. Concomitant coronary artery bypass grafting had no impact on short-term outcomes. Conclusions: Information derived from the nationwide database of patients with AMI-associated PMR show that PMR is a rare condition in the modern era. However, PMR is a severe disease with a mortality rate as high as 26%. The severity of the condition is associated with the risk for poor outcomes.

Original languageEnglish
JournalGeneral thoracic and cardiovascular surgery
DOIs
Publication statusAccepted/In press - 2020

Keywords

  • Acute mitral regurgitation
  • Acute myocardial infarction
  • Mitral valve repair
  • Mitral valve replacement
  • Papillary muscle rupture

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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