title: Surgical management of acute mitral valve regurgitation due to post-infarction papillary muscle rupture.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital, Zurich, Switzerland.
authors.forename: Reza
authors.initials: R
authors.lastname: Tavakoli
authors.forename: Alberto
authors.initials: A
authors.lastname: Weber
authors.forename: Paul
authors.initials: P
authors.lastname: Vogt
authors.forename: Hans-Peter
authors.initials: HP
authors.lastname: Brunner
authors.forename: Rene
authors.initials: R
authors.lastname: Pretre
authors.forename: Marko
authors.initials: M
authors.lastname: Turina
mesh_terms: D000208:Acute Disease; D000368:Aged; D009202:Cardiomyopathies / Q000150:complications*; D001026:Coronary Artery Bypass; D004630:Emergencies; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000150:complications* / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D010210:Papillary Muscles; D012422:Rupture, Spontaneous; D012770:Shock, Cardiogenic / Q000209:etiology / Q000601:surgery