Mitral Valve Surgery for Acute Papillary Muscle Rupture Following Myocardial Infarction
Qiang Chen MD, Malcolm J. Darlymple-Hay FRCS, Christos Alexious FRCS, Sunil K. Ohri FRCS, Marcus P. Haw FRCS, Steve A. Livesey FRCS, James L. Monro FRCS

Our experience of emergency mitral valve surgery of 33 patients with acute PMR following MI during the past 22 years is reviewed. Preoperatively, 79% patients required inotropic support and 52% an intra-aortic balloon pump (IABP). Twenty patients (61%) underwent concomitant coronary artery bypass grafting. 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). Early mortality was 21% (n = 7). Postoperatively, 21 patients required an IABP. 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 reoperation (three for paraprosthetic leak, one for a failed repair). In conclusion, patients with acute post-infarct PMR present in a severely compromised state. Early mortality was high, but the intermediate outcome was encouraging for operative survivors. In this setting, with friable tissues, mitral valve replacement is preferred.