Perioperative outcome and long-term survival of surgery for acute post-infarction mitral regurgitation.
OBJECTIVE
To determine factors predictive of mortality in patients undergoing emergency mitral valve surgery in the setting of severe post-infarction regurgitation.


METHODS
Patients admitted for an acute myocardial infarction who required urgent mitral valve surgery for severe regurgitation were studied. Factors predictive of outcome were analysed.


RESULTS
Fifty-five consecutive patients (mean 65+/-10 years, 37 males) were included. The infarct was inferior in 31 patients, posterior in 10, anterior in 9 and lateral in 5. Thirty-four patients (62%) were in Killip class IV. Peroperative findings confirmed total papillary muscle rupture in 25 patients (posteromedial in 21, anterolateral in 4), and partial rupture in 12 patients (posteromedial in 10, anterolateral in 2). Papillary muscle dysfunction without rupture was responsible for regurgitation in 18 patients (posteromedial in 15, anterolateral in 3). The mitral valve was replaced by a prosthesis in all but 4 patients, who had valvuloplasty. Coronary angiography was done in 32 patients, of whom 18 underwent concomitant coronary artery bypass grafting and 2 balloon angioplasty. Surgery was performed on average 7 days after infarction. Thirteen patients (24%) died during the perioperative period. Absence of coronary revascularisation was significantly associated with increased perioperative mortality (34% vs. 9%, P = 0.02). Of the 42 surviving patients, there were 5 deaths during a mean follow-up of 4.0+/-3.7 years.


CONCLUSIONS
In patients with acute post-infarction mitral regurgitation, perioperative mortality is high, but can be improved with concomitant CABG in addition to valve surgery. Long-term outcome of survivors is favourable.
Department of Cardiology and Intensive Care, Hôpital Louis Pradel, 28 Avenue Doyen Lepine, 69394 Lyon 03, France. philippe.chevalier@chu-lyon.fr
Philippe
P
Chevalier
Haran
H
Burri
Fadi
F
Fahrat
Michel
M
Cucherat
Olivier
O
Jegaden
Jean-François
JF
Obadia
Gilbert
G
Kirkorian
Paul
P
Touboul
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods; D001026:Coronary Artery Bypass / Q000379:methods; D005260:Female; D006342:Heart Rupture, Post-Infarction / Q000150:complications* / Q000401:mortality / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D010210:Papillary Muscles / Q000293:injuries; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology; D013997:Time Factors; D016896:Treatment Outcome