Key result
Mitral valve replacement was associated with significantly higher operative mortality compared to mitral valve repair (OR 5.47) for post-myocardial infarction papillary muscle rupture, though MVR patients were more often in cardiogenic shock.
Why the study?
Papillary muscle rupture post-MI requires surgery despite high risk, but the gold standard surgical technique remains a major dilemma.
Does mitral valve replacement compared to mitral valve repair improve operative mortality in patients with papillary muscle rupture post-myocardial infarction?
Meta-Analysis (n=1,640)
Does mitral valve replacement compared to mitral valve repair improve operative mortality in patients with papillary muscle rupture post-myocardial infarction?
Mitral valve repair is associated with lower operative mortality and shorter hospitalization compared to replacement for post-MI papillary muscle rupture, though replacement is more frequently performed in patients presenting with cardiogenic shock.
BACKGROUND: Papillary muscle rupture (PMR) is an infrequent but catastrophic complication after myocardial infarction (MI). Surgical procedure is considered the optimal treatment, despite high risk. However, the gold standard technique is still a major dilemma. Therefore, a meta-analysis was carried out to assess and provide an overview comparing mitral valve replacement (MVR) and mitral valve repair (MVr) for PMR post-MI. METHODS: A systematic literature search was performed. Data were extracted and verified using a standardized data extraction form. Meta-analysis was realized mainly using RevMan 5.4 software. RESULTS: From four observational studies 1640 patients were identified; 81% underwent MVR and 19% MVr. Operative mortality results were significantly higher in MVR group than the MVr group. MVR was performed under emergency conditions and patients admitted in cardiogenic shock or who required the use of mechanical cardiac support underwent MVR. MVr had shorter time of hospitalization and similar incidence of postoperative complications than MVR. No significant differences existed between the two procedures regarding cardiopulmonary bypass time. CONCLUSIONS: Mitral valve repair appears to be a viable alternative to MVR for post-MI PMR, given that it has lower operative mortality, shorter time of hospitalization and similar incidence of short-term postoperative complications than MVR. However, it needs to be pointed out that MVR was associated with the most critical clinical condition following PMR. There is uncertainty regarding the overall survival and improvement of the quality of life between the procedures. Nevertheless, further completed investigation is required.
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Pala et al. (2022) conducted a meta-analysis in Ischemic papillary muscle rupture post-myocardial infarction (n=1,640). Mitral valve replacement vs. Mitral valve repair was evaluated on Operative mortality (death within 30 days after surgery or in-hospital death) (OR 5.47, 95% CI 3.27-9.13, p=<0.00001). Mitral valve replacement was associated with significantly higher operative mortality compared to mitral valve repair (OR 5.47) for post-myocardial infarction papillary muscle rupture, though MVR patients were more often in cardiogenic shock.
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