Surgical treatment for post-infarction papillary muscle rupture: a multicentre study

Autor: Bart Meyns, Francesco Formica, Matteo Matteucci, Vittoria Lodo, Federica Torchio, Cinzia Trumello, Adam Kowalówka, Arjang Ruhparwar, Peyman Sardari Nia, Jurij M. Kalisnik, Massimiliano Carrozzini, Daniele Ronco, Giovanni Troise, Guglielmo Mario Actis Dato, Mariusz Kowalewski, Carlo Fino, Giulio Massimi, Stefano D'Alessandro, Theodor Fischlein, Giosuè Falcetta, Carlo Antona, Caterina Simon, Cesare Beghi, Matteo Pettinari, Roberto Scrofani, Claudio Russo, Valeria Lo Coco, Michele De Bonis, Emmanuel Villa, Marek A. Deja, Roberto Lorusso, Shabir Hussain Shah, Igor Vendramin, Sandro Sponga, Fareed A Khouqeer, Matthias Thielmann, Andrea Colli
Přispěvatelé: Massimi, G., Ronco, D., De Bonis, M., Kowalewski, M., Formica, F., Russo, C. F., Sponga, S., Vendramin, I., Falcetta, G., Fischlein, T., Troise, G., Trumello, C., Actis Dato, G., Carrozzini, M., Shah, S. H., Coco, V. L., Villa, E., Scrofani, R., Torchio, F., Antona, C., Kalisnik, J. M., D'Alessandro, S., Pettinari, M., Sardari Nia, P., Lodo, V., Colli, A., Ruhparwar, A., Thielmann, M., Meyns, B., Khouqeer, F. A., Fino, C., Simon, C., Kowalowka, A., Deja, M. A., Beghi, C., Matteucci, M., Lorusso, R., CTC, RS: Carim - V04 Surgical intervention, MUMC+: MA Alg Ond Onderz CTC (9), MUMC+: MA Med Staf Spec CTC (9)
Rok vydání: 2021
Předmět:
Zdroj: European Journal of Cardio-Thoracic Surgery, 61(2), 469-476. Oxford University Press
ISSN: 1873-734X
1010-7940
DOI: 10.1093/ejcts/ezab469
Popis: 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.
Databáze: OpenAIRE
Externí odkaz: