title: Clinical outcome after mitral valve surgery due to ischemic papillary muscle rupture.
abstract: BACKGROUND
  Severe mitral regurgitation secondary to papillary muscle rupture is an infrequent but catastrophic complication after myocardial infarction. Without surgical treatment, mortality can reach 80%, but surgical treatment also carries substantial perioperative morbidity and mortality.
  
  
  METHODS
  We retrospectively analyzed 28 patients who underwent mitral valve surgery for ischemic papillary muscle rupture.
  
  
  RESULTS
  The 30-day mortality rate was 39.3% (11 of 28). There were no significant differences in the baseline characteristics, and concomitant coronary artery bypass (CABG) was performed in 66.7% of the survivor group and in 61.5% of the nonsurvivor group (p = 0.245). Mortality predictors included low cardiac output (p = 0.05), renal failure (p = 0.005), and implementation of extracorporeal membrane oxygenation therapy (p = 0.005). The time between myocardial infarction and surgery showed no significant effects on survival.
  
  
  CONCLUSIONS
  Papillary muscle rupture with severe mitral regurgitation carries a high operative mortality. Additional CABG does not influence the acute postoperative course. Postoperative development of low cardiac output with a need for extracorporeal membrane oxygenation therapy and renal failure with hemodialysis substantially reduces survival.
authors.affiliation: Department of Cardiac Surgery, Heart Center Leipzig, University of Leipzig, Leipzig, Germany. thomas-schroeter@gmx.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Schroeter
authors.forename: Sven
authors.initials: S
authors.lastname: Lehmann
authors.forename: Martin
authors.initials: M
authors.lastname: Misfeld
authors.forename: Michael
authors.initials: M
authors.lastname: Borger
authors.forename: Sreekumar
authors.initials: S
authors.lastname: Subramanian
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
authors.forename: Farhad
authors.initials: F
authors.lastname: Bakthiary
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006342:Heart Rupture, Post-Infarction / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D010210:Papillary Muscles; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome