Surgical management of acute mitral valve regurgitation due to post-infarction papillary muscle rupture

J Heart Valve Dis. 2002 Jan;11(1):20-5; discussion 26.


Background and aim of the study: Acute myocardial infarction associated with mitral papillary muscle rupture and cardiogenic shock carries a high mortality. Data relating to early and late survival after emergency mitral valve surgery and concomitant complete coronary artery revascularization in this patient population were analyzed.

Methods: Between January 1988 and December 1998, 21 consecutive patients (mean age 62+/-9.7 years) underwent emergency coronary and concomitant mitral valve surgery for acute myocardial infarction and mitral papillary muscle rupture associated with cardiogenic shock. Mitral valve replacement was performed in 19 patients (90%), and mitral valve repair in two (10%). An average of 2.2 distal anastomoses per patient was performed. Revascularization was complete in 19 patients (90%). Preoperatively, intra-aortic balloon pumping was used in 11 patients (52%), and two (10%) had salvage surgery when arriving at the operating room under cardiopulmonary resuscitation. Early and late follow up was complete; mean follow up was 5+/-3 years (range: 16 months to 12 years).

Results: Thirty-day mortality was 19% (4/21), with two cardiac-related early deaths (10%). Early morbidity included perioperative stroke in 6% (1/17), myocardial infarction in 6% (1/17), and need for hemodialysis in 18% (3/17). There were three late deaths; one was cardiac-related. Actuarial survival at one, five and 10 years was 81, 68 and 56%, respectively. All survivors were in NYHA class I or II.

Conclusion: Emergency surgery for acute post-infarction mitral papillary muscle rupture is justified, even as a salvage procedure. Concomitant mitral valve surgery and complete coronary artery revascularization achieve acceptable survival rates and satisfactory functional results.

MeSH terms

  • Acute Disease
  • Aged
  • Cardiomyopathies / complications*
  • Coronary Artery Bypass*
  • Emergencies
  • Female
  • Heart Rupture, Post-Infarction / complications*
  • Heart Rupture, Post-Infarction / physiopathology
  • Heart Rupture, Post-Infarction / surgery*
  • Heart Valve Prosthesis Implantation
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Mitral Valve / surgery
  • Mitral Valve Insufficiency / etiology
  • Mitral Valve Insufficiency / physiopathology
  • Mitral Valve Insufficiency / surgery*
  • Papillary Muscles*
  • Rupture, Spontaneous
  • Shock, Cardiogenic / etiology
  • Shock, Cardiogenic / surgery