Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Aug;47(8):1386-1394.
doi: 10.1111/aor.14541. Epub 2023 Apr 25.

Extracorporeal life support in mitral papillary muscle rupture: Outcome of multicenter study

Giulio Massimi  1   2 , Matteo Matteucci  1   3 , Michele De Bonis  4 , Mariusz Kowalewski  1   5 , Francesco Formica  6   7 , Claudio Francesco Russo  8 , Sandro Sponga  9 , Igor Vendramin  9 , Andrea Colli  10 , Giosuè Falcetta  10 , Cinzia Trumello  4 , Massimiliano Carrozzini  8 , Theodor Fischlein  11 , Giovanni Troise  12 , Guglielmo Actis Dato  13 , Stefano D'Alessandro  6 , Peyman Sardari Nia  1 , Vittoria Lodo  13 , Emmanuel Villa  12 , Shabir Hussain Shah  14 , Roberto Scrofani  15 , Irene Binaco  15 , Jurij Matija Kalisnik  11 , Matteo Pettinari  16 , Matthias Thielmann  17 , Bart Meyns  18 , Fareed A Khouqeer  19 , Carlo Fino  20 , Caterina Simon  20 , Paolo Severgnini  3 , Adam Kowalowka  21 , Marek A Deja  21 , Daniele Ronco  3 , Roberto Lorusso  1   22
Affiliations
Multicenter Study

Extracorporeal life support in mitral papillary muscle rupture: Outcome of multicenter study

Giulio Massimi et al. Artif Organs. 2023 Aug.

Abstract

Background: Post-acute myocardial infarction papillary muscle rupture (post-AMI PMR) may present variable clinical scenarios and degree of emergency due to result of cardiogenic shock. Veno-arterial extracorporeal life support (V-A ECLS) has been proposed to improve extremely poor pre- or postoperative conditions. Information in this respect is scarce.

Methods: From the CAUTION (meChanical complicAtion of acUte myocardial infarcTion: an InternatiOnal multiceNter cohort study) database (16 different Centers, data from 2001 to 2018), we extracted adult patients who were surgically treated for post-AMI PMR and underwent pre- or/and postoperative V-A ECLS support. The end-points of this study were in-hospital survival and ECLS complications.

Results: From a total of 214 post-AMI PMR patients submitted to surgery, V-A ECLS was instituted in 23 (11%) patients. The median age was 61.7 years (range 46-81 years). Preoperatively, ECLS was commenced in 10 patients (43.5%), whereas intra/postoperative in the remaining 13. The most common V-A ECLS indication was post-cardiotomy shock, followed by preoperative cardiogenic shock and cardiac arrest. The median duration of V-A ECLS was 4 days. V-A ECLS complications occurred in more than half of the patients. Overall, in-hospital mortality was 39.2% (9/23), compared to 22% (42/219) for the non-ECLS group.

Conclusions: In post-AMI PMR patients, V-A ECLS was used in almost 10% of the patients either to promote bridge to surgery or as postoperative support. Further investigations are required to better evaluate a potential for increased use and its effects of V-A ECLS in such a context based on the still high perioperative mortality.

Keywords: acute myocardial infarction; mitral regurgitation; papillary muscle rupture.

PubMed Disclaimer

References

REFERENCES

    1. Elbadawi A, Elgendy IY, Mahmoud K, Barakat AF, Mentias A, Mohamed AH, et al. Temporal trends and outcomes of mechanical complications in patients with acute myocardial infarction. JACC Cardiovasc Interv. 2019;12(18):1825-36.
    1. Nishimura RA, Schaff HV, Shub C, Gersh BJ, Edwards WD, Tajik AJ. Papillary muscle rupture complicating acute myocardial infarction: analysis of 17 patients. Am J Cardiol. 1983;51(3):373-7.
    1. Birnbaum Y, Chamoun AJ, Conti VR, Uretsky BF. Mitral regurgitation following acute myocardial infarction. Coron Artery Dis. 2002;13(6):337-44.
    1. Watkins AC, Maassel NL, Ghoreishi M, Dawood MY, Pham SM, Kon ZN, et al. Preoperative venoarterial extracorporeal membrane oxygenation slashes risk score in advanced structural heart disease. Ann Thorac Surg. 2018;106(6):1709-15. https://doi.org/10.1016/j.athoracsur.2018.07.038
    1. Sousa-Uva M, Neumann FJ, Ahlsson A, Alfonso F, Banning AP, Benedetto U, et al. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur J Cardiothorac Surg. 2019;55:4-90.

Publication types

LinkOut - more resources