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

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 independ- ent 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 ¼ .008), while partial PMR was more frequent in MVr patients (75%, P ¼ .008). In-hospital mortality rate was 25.8% in the MVR subgroup and 20% in MVr subjects (P ¼ .440). In MVR subgroup, concomitant coronary artery by- pass grafting (CABG) was associated with lower in-hospital mortality (n ¼ 20/96, 21%) than no concomitant CABG (31.7%, P ¼ .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, re- spectively, with no statistical differences (P ¼ .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.