This Article Full Text Full Text (PDF) CME: Take the course for this article: Circulation: October 7, 2008, Volume 118, Number 15 All Versions of this Article: 118/15/1528    most recent CIRCULATIONAHA.107.747949v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Russo, A. Articles by Enriquez-Sarano, M. Search for Related Content PubMed PubMed Citation Articles by Russo, A. Articles by Enriquez-Sarano, M. Pubmed/NCBI databases Medline Plus Health Information Heart Attack Heart Surgery Related Collections Echocardiography CV surgery: valvular disease Acute myocardial infarction Related Article

(Circulation. 2008;118:1528-1534.)
© 2008 American Heart Association, Inc.

Cardiovascular Surgery

Clinical Outcome After Surgical Correction of Mitral Regurgitation Due to Papillary Muscle Rupture

Antonio Russo, MD; Rakesh M. Suri, MD; Francesco Grigioni, MD; Véronique L. Roger, MD, MPH; Jae K. Oh, MD; Douglas W. Mahoney, MS; Hartzell V. Schaff, MD; Maurice Enriquez-Sarano, MD

From the Divisions of Cardiovascular Diseases and Internal Medicine (A.R., F.G., V.L.R., J.K.O., M.E.-S.), Biostatistics (D.W.M.), and Cardiovascular Surgery (R.M.S., H.V.S.), Mayo Clinic, Rochester, Minn.

Correspondence to Maurice Enriquez-Sarano, MD, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail Sarano.maurice{at}mayo.edu

Received October 22, 2007; accepted August 4, 2008.

Background— Papillary muscle rupture (PMR) is an infrequent but catastrophic complication of acute myocardial infarction (MI). Although always considered, surgical treatment is often denied because of high operative mortality. Moreover, the effects of surgery for PMR on long-term outcome, particularly compared with expected outcome after MI, are undefined.

Methods and Results— Fifty-four consecutive patients (age, 70±8 years; 74% male) underwent mitral surgery for post-MI PMR from January 1980 through December 2000. Severe presentation (cardiogenic shock, pulmonary edema, or cardiac arrest) was noted in 91% preoperatively. Performance of coronary artery bypass graft was associated with lower operative mortality (odds ratio, 0.18; 95% CI, 0.04 to 0.83; P=0.011), whereas there was a trend for lower mortality after surgery after 1990 (odds ratio, 0.28; 95% CI, 0.06 to 1.3). Thus, operative mortality (overall, 18.5%) decreased from 67% up to 1990 without coronary artery bypass graft to 8.7% after 1990 with coronary artery bypass graft. Overall 5-year survival was 65±7%, and survival free of congestive heart failure was 52±7%. Five-year survival of 30-day operative survivors was 79±4%, identical (P=0.24) to that of matched controls with MI (similar age, sex, ejection fraction, MI location, and MI year). Survival free of congestive heart failure was similar in PMR cases and MI controls (10-year survival, 28±8% versus 36±6%; P=0.46).

Conclusions— Surgery for post-MI PMR involves a notable operative mortality, but there are recent trends for lower operative risk, particularly with associated coronary artery bypass graft. Long term after surgery, outcome is restored to that of similar MI without PMR. These encouraging observations emphasize the importance of prompt diagnosis and aggressive therapeutic approach for patients incurring PMR after MI.

---

 

CLINICAL PERSPECTIVE

Related Article:

Clinical Summaries
Circulation 2008 118: 1519-1520. [Extract] [Full Text]

This article has been cited by other articles:

				K. K. Stout and E. D. Verrier Acute Valvular Regurgitation Circulation, June 30, 2009; 119(25): 3232 - 3241. [Full Text] [PDF]