Document Detail

Clinical outcome after surgical correction of mitral regurgitation due to papillary muscle rupture.
MedLine Citation:
PMID:  18809799     Owner:  NLM     Status:  MEDLINE    
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.
Antonio Russo; Rakesh M Suri; Francesco Grigioni; Véronique L Roger; Jae K Oh; Douglas W Mahoney; Hartzell V Schaff; Maurice Enriquez-Sarano
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Publication Detail:
Type:  Controlled Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-09-22
Journal Detail:
Title:  Circulation     Volume:  118     ISSN:  1524-4539     ISO Abbreviation:  Circulation     Publication Date:  2008 Oct 
Date Detail:
Created Date:  2008-10-07     Completed Date:  2008-10-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0147763     Medline TA:  Circulation     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1528-34     Citation Subset:  AIM; IM    
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
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MeSH Terms
Cardiac Surgical Procedures / mortality*
Cohort Studies
Coronary Artery Bypass / mortality
Disease-Free Survival
Follow-Up Studies
Heart Failure / mortality
Middle Aged
Mitral Valve Insufficiency / etiology,  mortality*,  surgery*
Myocardial Infarction / complications,  mortality*,  surgery*
Papillary Muscles / pathology*
Postoperative Complications / mortality
Risk Factors
Rupture, Spontaneous
Treatment Outcome

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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