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Multicenter Study
. 2025 Sep 2;67(9):ezaf284.
doi: 10.1093/ejcts/ezaf284.

Repair Versus Replacement in Mitral Valve Papillary Muscle Rupture: A 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 , Marco Dell'Uomo  2 , Matteo Pettinari  16 , Matthias Thielmann  17 , Bart Meyns  18 , Fareed A Khouqeer  19 , Carlo Fino  20 , Caterina Simon  20 , Andrea Musazzi  3 , Adam Kowalowka  21 , Marek A Deja  21 , Angelo Pisani  22 , Jakub Batko  5   23 , Valentino Borghetti  2 , Daniele Ronco  1   8 , Michele Di Mauro  1 , Roberto Lorusso  1   24
Affiliations
Multicenter Study

Repair Versus Replacement in Mitral Valve Papillary Muscle Rupture: A Multicenter Study

Giulio Massimi et al. Eur J Cardiothorac Surg. .

Abstract

Objectives: Papillary muscle rupture (PMR) is a rare but potentially fatal mechanical complication after acute myocardial infarction (AMI). Although surgery is considered the gold-standard treatment for post-AMI PMR, the optimal surgical strategy remains unclear.

Methods: Data from post-AMI PMR patients submitted to mitral valve replacement (MVR) or mitral valve repair (MVr) surgery in the period between 2001 and 2019, from 20 international centres, were collected in the CAUTION study database. In-hospital and long-term post-discharge mortality were the endpoints. A multivariable logistic regression model was used to determine mortality independent factors.

Results: The patient cohort available included 218 patients. MVR was the most frequent type of surgery (81.6%). Complete PMR was more common in the MVR group (71.9%, P = .008), while partial PMR was more frequent in MVr patients (75%, P = .008). In-hospital mortality rate was 25.8% in the MVR subgroup and 20% in MVr subjects (P = .440). In MVR subgroup, concomitant coronary artery bypass grafting (CABG) was associated with lower in-hospital mortality (n = 20/96, 21%) than no concomitant CABG (31.7%, P = .035). Survival at 1, 3, 5, and 10 years was 59.3%, 55.9%, 53.1%, 46.9% in the MVR group and 59.9%, 56.8%, 54.1%, and 43.2% in MVr patients, respectively, with no statistical differences (P = .474). Patients underwent MVr surgery, and 1-, 3-, 5-, and 10-year survival was 79.8%, 75.4%, 68.5%, and 37.5%, respectively, when CABG revascularization was performed, while no CABG survival was 16.7%, 16.7%, 8.3%, and 8.3% (P < .001).

Conclusions: MVR is the most commonly performed in complete post-AMI PMR and MVr in partial PMR. No differences were observed regarding in-hospital and long-term mortality in the 2 surgical groups, and no independent factors were associated with overall mortality. Concomitant CABG was associated with higher in-hospital survival.

Clinical registration number: Clinicaltrials.gov, NCT03848429.

Keywords: mitral valve; mitral valve repair; mitral valve replacement; myocardial infarction; papillary muscle rupture.

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Conflict of interest statement

R.L. is a consultant for Medtronic and LivaNova and a member of the Advisory Board of Eurosets and PulseCath.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Postoperative Outcomes in MVR and MVr in Post-AMI PMR Populations. Abbreviations: AMI = acute myocardial infarction; MVR = mitral valve replacement; MVr = mitral valve repair; PMR = papillary muscle rupture
Figure 2.
Figure 2.
Kaplan-Meier Curves of Survival for MVR and MVr in Post-AMI PMR Population. Abbreviations: AMI = acute myocardial infarction; MVR = mitral valve replacement; MVr = mitral valve repair; PMR = papillary muscle rupture
Figure 3.
Figure 3.
Kaplan-Meier Curves of Survival for Post-AMI Patients Who Underwent MVR With and Without Concomitant CABG Revascularization. AMI = acute myocardial infarction; CABG = coronary artery bypass grafting; MVR = mitral valve replacement
Figure 4.
Figure 4.
Kaplan-Meier Curves of Survival for Post-AMI Patients Who Underwent MVr With and Without Concomitant CABG Revascularization. Abbreviations: AMI = acute myocardial infarction; CABG = coronary artery bypass grafting; MVr = mitral valve repair
See this image and copyright information in PMC

References

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