Key result
Mitral valve replacement without preservation of the subvalvular apparatus was a strong independent predictor of lower overall long-term survival (HR 3.40) in patients with post-myocardial infarction papillary muscle rupture.
Why the study?
What are the predictors of long-term survival in patients undergoing mitral valve surgery for post-myocardial infarction papillary muscle rupture?
Cohort (n=50)
No
What are the predictors of long-term survival in patients undergoing mitral valve surgery for post-myocardial infarction papillary muscle rupture?
In patients undergoing mitral valve surgery for post-myocardial infarction papillary muscle rupture, preservation of the subvalvular apparatus and avoidance of preoperative inotropic support are associated with improved long-term survival.
Answers are grounded in this paper and cite their sources.
Preservation of subvalvular apparatus may improve survival in post-MI papillary muscle rupture surgery; leaves open need for prospective confirmation.
BACKGROUND: Papillary muscle rupture (PMR) is a rare, but dramatic mechanical complication of myocardial infarction (MI), which can lead to rapid clinical deterioration and death. Immediate surgical intervention is considered the optimal and most rational treatment, despite high risks. In this study we sought to identify overall long-term survival and its predictors for patients who underwent mitral valve surgery for post-MI PMR. METHODS: Fifty consecutive patients (mean age 64.7±10.8 years) underwent mitral valve repair (n=10) or replacement (n=40) for post-MI PMR from January 1990 through May 2014. Clinical data, echocardiographic data, catheterization data, and surgical data were stored in a dedicated database. Follow-up was obtained in June of 2014; mean follow-up was 7.1±6.8 years (range 0.0-22.2 years). Univariate and multivariate Cox proportional hazard regression analyses were performed to identify predictors of long-term survival. Kaplan-Meier curves were compared with the log-rank test. RESULTS: Kaplan-Meier cumulative survival at 1, 5, 10, 15, and 20 years was 71.9±6.4%, 65.1±6.9%, 49.5±7.6%, 36.1±8.0% and 23.7±9.2%, respectively. Univariate and multivariate analyses revealed logistic EuroSCORE≥40% and EuroSCORE II≥25% as strong independent predictors of a lower overall long-term survival. After removal of the EuroSCOREs from the model, preoperative inotropic drug support and mitral valve replacement (MVR) without (partial or complete) preservation of the subvalvular apparatus were independent predictors of a lower overall long-term survival. CONCLUSIONS: Logistic EuroSCORE≥40%, EuroSCORE II≥25%, preoperative inotropic drug support and MVR without (partial or complete) preservation of the subvalvular apparatus are strong independent predictors of a lower overall long-term survival in patients undergoing mitral valve surgery for post-MI PMR. Whenever possible, the subvalvular apparatus should be preserved in these patients.
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Bouma et al. (2015) conducted a cohort in Post-myocardial infarction papillary muscle rupture (n=50). Mitral valve replacement without preservation of the subvalvular apparatus vs. Mitral valve surgery with preservation of the subvalvular apparatus was evaluated on Overall long-term survival (HR 3.40, 95% CI 1.19-9.69, p=0.022). Mitral valve replacement without preservation of the subvalvular apparatus was a strong independent predictor of lower overall long-term survival (HR 3.40) in patients with post-myocardial infarction papillary muscle rupture.
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