TY - JOUR
T1 - Mitral valve surgery for ischemic papillary muscle rupture
T2 - outcomes from the Japan cardiovascular surgery database
AU - Fujita, Tomoyuki
AU - Yamamoto, Hiroyuki
AU - Kobayashi, Junjiro
AU - Fukushima, Satsuki
AU - Miyata, Hiroaki
AU - Yamashita, Kizuku
AU - Motomura, Noboru
N1 - Funding Information:
HY and HM are affiliated with the Department of Healthcare Quality Assessment at The University of Tokyo, which is a social collaboration department supported by Grants from National Clinical Database, Johnson & Johnson K.K., and Nipro Co. TF, KY, JK, and SF have no conflicts of interest.
Funding Information:
This work was supported by The Japanese Society for Cardiovascular Surgery Clinical Investigation Project Award in 2017. Acknowledgement
Publisher Copyright:
© 2020, The Author(s).
PY - 2020/12
Y1 - 2020/12
N2 - 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.
AB - 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.
KW - Acute mitral regurgitation
KW - Acute myocardial infarction
KW - Mitral valve repair
KW - Mitral valve replacement
KW - Papillary muscle rupture
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U2 - 10.1007/s11748-020-01418-y
DO - 10.1007/s11748-020-01418-y
M3 - Article
C2 - 32588291
AN - SCOPUS:85086835290
VL - 68
SP - 1439
EP - 1446
JO - General Thoracic and Cardiovascular Surgery
JF - General Thoracic and Cardiovascular Surgery
SN - 1863-6705
IS - 12
ER -