Giulio Massimi1, Daniele Ronco1,2, Michele De Bonis3, Mariusz Kowalewski1,4, Francesco Formica5,6, Claudio Francesco Russo7, Sandro Sponga8, Igor Vendramin8, Giosuè Falcetta9, Theodor Fischlein10, Giovanni Troise11, Cinzia Trumello3, Guglielmo Actis Dato12, Massimiliano Carrozzini7, Shabir Hussain Shah13, Valeria Lo Coco1, Emmanuel Villa11, Roberto Scrofani14, Federica Torchio2, Carlo Antona14, Jurij Matija Kalisnik10, Stefano D'Alessandro5, Matteo Pettinari15, Peyman Sardari Nia1, Vittoria Lodo12, Andrea Colli9, Arjang Ruhparwar16, Matthias Thielmann16, Bart Meyns17, Fareed A Khouqeer18, Carlo Fino19, Caterina Simon19, Adam Kowalowka20, Marek A Deja20, Cesare Beghi2, Matteo Matteucci1,2, Roberto Lorusso1,21. 1. Department of Cardiothoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands. 2. Department of Medicine and Surgery, Circolo Hospital, University of Insubria, Varese, Italy. 3. Cardiothoracic Surgery Department, San Raffaele University Hospital, Milan, Italy. 4. Thoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland. 5. Department of Medicine and Surgery, Cardiac Surgery Clinic, San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy. 6. Department of Medicine and Surgery, University of Parma, Cardiac Surgery Unit, University Hospital of Parma, Parma, Italy. 7. Cardiac Surgery Unit, Cardio-Thoraco-Vascular Department, Niguarda Hospital, Milan, Italy. 8. Cardiothoracic Department, University Hospital of Udine, Udine, Italy. 9. Section of Cardiac Surgery, University Hospital, Pisa, Italy. 10. Department of Cardiac Surgery, Cardiovascular Center, Klinikum Nürnberg, Paracelsus Medical University, Nuremberg, Germany. 11. Cardiac Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy. 12. Cardiac Surgery Department, Mauriziano Hospital, Turin, Italy. 13. Cardiovascular and Thoracic Surgery Department, King Fahad Medical City, Riyadh, Saudi Arabia. 14. Cardiac Surgery Unit, Luigi Sacco Hospital, Milan, Italy. 15. Department of Cardiovascular Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium. 16. Department of Thoracic and Cardiovascular Surgery, West-German Heart and Vascular Center, University of Duisburg-Essen, Essen, Germany. 17. Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium. 18. Department of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. 19. Cardiovascular Department, Papa Giovanni XXIII Hospital, Bergamo, Italy. 20. Department of Cardiac Surgery, Medical University of Silesia, Katowice, Poland. 21. Cardiovascular Research Institute Maastricht, Maastricht, Netherlands.
Abstract
OBJECTIVES: Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry. METHODS: Patients underwent surgery for post-infarction PMR between 2001 through 2019 were retrieved from database of the CAUTION study. The primary end point was in-hospital mortality. RESULTS: A total of 214 patients were included with a mean age of 66.9 (standard deviation: 10.5) years. The posteromedial papillary muscle was the most frequent rupture location (71.9%); the rupture was complete in 67.3% of patients. Mitral valve replacement was performed in 82.7% of cases. One hundred twenty-two patients (57%) had concomitant coronary artery bypass grafting. In-hospital mortality was 24.8%. Temporal trends revealed no apparent improvement in in-hospital mortality during the study period. Multivariable analysis showed that preoperative chronic kidney disfunction [odds ratio (OR): 2.62, 95% confidence interval (CI): 1.07-6.45, P = 0.036], cardiac arrest (OR: 3.99, 95% CI: 1.02-15.61, P = 0.046) and cardiopulmonary bypass duration (OR: 1.01, 95% CI: 1.00-1.02, P = 0.04) were independently associated with an increased risk of in-hospital death, whereas concomitant coronary artery bypass grafting was identified as an independent predictor of early survival (OR: 0.38, 95% CI: 0.16-0.92, P = 0.031). CONCLUSIONS: Surgical treatment for post-infarction PMR carries a high in-hospital mortality rate, which did not improve during the study period. Because concomitant coronary artery bypass grafting confers a survival benefit, this additional procedure should be performed, whenever possible, in an attempt to improve the outcome. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov: NCT03848429.
OBJECTIVES: Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry. METHODS: Patients underwent surgery for post-infarction PMR between 2001 through 2019 were retrieved from database of the CAUTION study. The primary end point was in-hospital mortality. RESULTS: A total of 214 patients were included with a mean age of 66.9 (standard deviation: 10.5) years. The posteromedial papillary muscle was the most frequent rupture location (71.9%); the rupture was complete in 67.3% of patients. Mitral valve replacement was performed in 82.7% of cases. One hundred twenty-two patients (57%) had concomitant coronary artery bypass grafting. In-hospital mortality was 24.8%. Temporal trends revealed no apparent improvement in in-hospital mortality during the study period. Multivariable analysis showed that preoperative chronic kidney disfunction [odds ratio (OR): 2.62, 95% confidence interval (CI): 1.07-6.45, P = 0.036], cardiac arrest (OR: 3.99, 95% CI: 1.02-15.61, P = 0.046) and cardiopulmonary bypass duration (OR: 1.01, 95% CI: 1.00-1.02, P = 0.04) were independently associated with an increased risk of in-hospital death, whereas concomitant coronary artery bypass grafting was identified as an independent predictor of early survival (OR: 0.38, 95% CI: 0.16-0.92, P = 0.031). CONCLUSIONS: Surgical treatment for post-infarction PMR carries a high in-hospital mortality rate, which did not improve during the study period. Because concomitant coronary artery bypass grafting confers a survival benefit, this additional procedure should be performed, whenever possible, in an attempt to improve the outcome. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov: NCT03848429.
Authors: Giulio Massimi; Matteo Matteucci; Mariusz Kowalewski; Daniele Ronco; Giovanni Chiarini; Maria Elena De Piero; Valeria Lo Coco; Jos G Maessen; Cesare Beghi; Roberto Lorusso Journal: Ann Cardiothorac Surg Date: 2022-05