title: Mitral valve surgery for acute papillary muscle rupture following myocardial infarction.
abstract: OBJECTIVE
  Acute papillary muscle rupture (PMR) is a rare but fatal complication of myocardial infarction (MI). Surgery represents the best treatment option, but carries a high risk. Our experience of emergency mitral valve surgery in patients with acute PMR following MI during the past 22 years is reviewed.
  
  
  METHODS
  Between 1978 and 2000, 33 patients (20 males, 13 females; mean age 64 years; range: 46-80) underwent emergency surgery for acute post-infarct PMR in our institution. The site of MI was anterior in three patients and inferior in 30. Preoperatively, 17 patients had an intra-aortic balloon pump (IABP) inserted, 26 were on inotropic support, and 17 were ventilated. Twenty patients (61%) underwent concomitant coronary bypass grafting (CABG). The valve was replaced in 31 patients and repaired in two. Mean (+/- SD) duration of follow up was 63+/-54 months (range: 0-183 months).
  
  
  RESULTS
  Early mortality (in-hospital) was 21% (n = 7). Factors associated with significant risk of early mortality included raised preoperative serum creatinine (p = 0.02), need for preoperative inotropic support (p = 0.03) and preoperative ventilation (p = 0.03). Raised preoperative serum creatinine remained significant on multiple logistic regression (p = 0.04). Postoperatively, 21 patients required an IABP. Mean duration of intensive care unit stay was 4+/-2.5 days (range: 0-10 days). Survival, including in-hospital mortality, at one, five and 10 years was 75+/-7.4, 65+/-8.6 and 32+/-9.7%, respectively. Four patients required valve-related reoperation (three for a paraprosthetic leak, one for failed repair).
  
  
  CONCLUSIONS
  Patients with acute post-infarct PMR present in a severely compromised state. Early mortality is high, but the intermediate outcome is encouraging for operative survivors.
authors.affiliation: Department of Cardiac Surgery, Southampton General Hospital, UK.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Chen
authors.forename: Malcolm J
authors.initials: MJ
authors.lastname: Darlymple-Hay
authors.forename: Christos
authors.initials: C
authors.lastname: Alexiou
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Ohri
authors.forename: Marcus P
authors.initials: MP
authors.lastname: Haw
authors.forename: Steve A
authors.initials: SA
authors.lastname: Livesey
authors.forename: James L
authors.initials: JL
authors.lastname: Monro
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D009202:Cardiomyopathies / Q000150:complications* / Q000601:surgery; D001026:Coronary Artery Bypass; D004630:Emergencies; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery*; D010210:Papillary Muscles; D012086:Reoperation